Jaffar A Al-Tawfiq1, Ali A Rabaan2, Ali M Bazzi3, Safia Raza4, Madeeha Noureen4. 1. Infectious Disease Unit, Specialty Internal Medicine, Department and Quality & Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaffar.tawfiq@jhah.com. 2. Molecular Diagnostic Lab, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 3. Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 4. Division of Hospital Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
Abstract
BACKGROUND: Clostridioides (Clostridium) difficile infection (CDI) is an important health care-associated infection with variable incidence and prevalence across the globe. There are limited data from Saudi Arabia on the epidemiology of C. difficile-associated diarrhea (CDAD). In this study, we present the epidemiology and incidence of CDAD in a hospital in Saudi Arabia. METHODS: This study included all stool samples from 2001 to 2018 that were tested for C. difficile. C. difficile toxins were detected by enzyme-linked immunosorbent assay in 2001-2012 and the diagnosis was based on PCR testing (2013-2018). RESULTS: There was a total of 577 distinctive episodes of CDAD representing 5.2% of 10,995 tested stool samples with an annual positivity rate of 0.9%-11.8%. Of all CDAD cases, there were 230 (39.9%) community associated-CDAD, 105 (18.2%) community onset-health care facility associated disease, and 242 (42%) health care facility onset health care facility-associated disease (HCFO-HCFAD). There was a trend of increasing percentage of community onset-health care facility associated disease cases from 17% in 2001 to 20% in 2018 of all cases, and a trend towards less cases of community associated-CDAD from 85% to 50% over time. However, the percentages of HCFO-HCFAD percentages remained relatively stable. The rate of HCFO-HCFAD per 1,000 patient-days increased from 0.009 to 0.22 from 2001 to 2018, respectively. CONCLUSIONS: The rate of CDAD was 5.15% among all tested samples and that there is a large proportion of community associated-CDAD. The findings parallel the data from developed countries and deserve further studies in the risk factors for community-associated CDAD.
BACKGROUND:Clostridioides (Clostridium) difficileinfection (CDI) is an important health care-associated infection with variable incidence and prevalence across the globe. There are limited data from Saudi Arabia on the epidemiology of C. difficile-associated diarrhea (CDAD). In this study, we present the epidemiology and incidence of CDAD in a hospital in Saudi Arabia. METHODS: This study included all stool samples from 2001 to 2018 that were tested for C. difficile. C. difficile toxins were detected by enzyme-linked immunosorbent assay in 2001-2012 and the diagnosis was based on PCR testing (2013-2018). RESULTS: There was a total of 577 distinctive episodes of CDAD representing 5.2% of 10,995 tested stool samples with an annual positivity rate of 0.9%-11.8%. Of all CDAD cases, there were 230 (39.9%) community associated-CDAD, 105 (18.2%) community onset-health care facility associated disease, and 242 (42%) health care facility onset health care facility-associated disease (HCFO-HCFAD). There was a trend of increasing percentage of community onset-health care facility associated disease cases from 17% in 2001 to 20% in 2018 of all cases, and a trend towards less cases of community associated-CDAD from 85% to 50% over time. However, the percentages of HCFO-HCFAD percentages remained relatively stable. The rate of HCFO-HCFAD per 1,000 patient-days increased from 0.009 to 0.22 from 2001 to 2018, respectively. CONCLUSIONS: The rate of CDAD was 5.15% among all tested samples and that there is a large proportion of community associated-CDAD. The findings parallel the data from developed countries and deserve further studies in the risk factors for community-associated CDAD.