Background: To understand the incidence of and risk factors for toxins (A+B) production in Clostridium difficile (CD) isolated from hospitalized patients with enterocolitis.
Methods: During 2008, all CD strains isolated from patients with enterocolitis who hospitalized in a hospital at Southern Taiwan were included in this study. Toxins productions of CD strains were screened by immunoassays (TOX A/B QUIK CHEKTM), and the presence of toxin-A and toxin-B was further confirmed by PCR. Demographics and clinical data (such as intensive care unit [ICU] staying, and recent antibiotics exposure history) of the patients were analyzed to identify the risk factor(s) for positivity of toxins (A+B) production in CD strains.
Results: Overall 115 CD strains; each isolated from each one patient were included and 58 (50.4%) were positive for toxin (A+B) production. None of CD isolates was found to have either toxin A or toxin B alone. Comparied with patients with toxins (A+B)-negative CD isolates, there were no significant differences in underlying diseases, ICU staying, and the antibiotics class of recent exposure history in patients with toxins (A+B)-positive CD isolates. Of note, only higher frequency of diarrhea (5.05 times/per day vs. 2.96 times/per day; p <0.01) was found in patients with toxins (A+B)-positive CD.
Conclusion: These results indicate that half a CD strains isolated from hospitalized patients with enterocolitis harbored toxin production. It is difficult to make a differential diagnosis between enterocolitis caused by toxin-producing strains or non-toxin producing strains. Hence it is important to toxin test toxin production for patients with enterocolitis.