High prevalence of toxinogenic Clostridium difficile in Nigerian adult HIV patients.

Clostridium difficile is the most commonly identified bacterial cause of nosocomial and HIV-related diarrhea. In many developing countries, antibiotic access is unregulated. Nigeria has the third highest HIV burden worldwide. Due to perceptions of low prevalence and resource incapacity, patients with diarrhea are not tested for toxinogenic C. difficile infection (CDI). In this pilot study which included 97 HIV-positive patients at two hospitals in Nigeria, the estimated prevalence of CDI was 43% and 14% for in-patients and out-patients respectively. HIV-positive out-patients were more likely to have toxinogenic CDI than non-HIV out-patients (P=0.007, Fisher's exact test).