Abstract

Background: Clostridium difficile (C. difficile) is the most common antibiotic-associated diarrhoea agent in selected patients. C. difficile strains are classified as toxigenic or non-toxigenic based on their ability to produce toxins.
Aim: The frequency of C. difficile and CDAD among patients in a tertiary hospital in Patna, India was investigated in this study.
Methods: From the patients, a total of 233 diarrheal samples were extracted. The samples were cultivated on Clostridium difficile medium with cycloserine (500 mg/L), cefoxitin (16 mg/L), and lysozyme (5mg/L) and 5 per cent defibrinated sheep blood. Polymerase chain reaction (PCR) of the 16s rRNA gene identified the isolates as C. difficile, as did the presence of toxins genes (tcdA, tcdB, cdtA, and cdtB). The toxin production of isolates was then assessed using Rapid Card (CerTest BioTech SL Spain).
Results: C. difficile was identified from 49 (21%) of the 233 samples tested. The total isolates were classified as A^-/B^-/GDH^‑ (48.97%), A⁺/B^-/GDH^- (28%), A⁺/B⁺/GDH^‑ (20.4%) and A⁺/B⁺/GDH⁺ (2%) types. Both types of C.difficile, A^-/B^-/GDH^‑and A⁺/B^-/GDH^-, which account for 77.5 per cent of all isolates, were both unable to generate the toxin (nontoxigenic). However, A⁺/B⁺/GDH⁺ and A⁺/B⁺/GDH^‑ (22.5%), were able to manufacture toxin or were toxigenic.
Conclusion: The prevalence of C. difficile was approximately 21%, and only 22.4 percent of C. difficile isolates were capable of producing toxins. C. difficile A⁺/B⁺/GDH^± are likely to be toxigenic and linked to C. difficile-associated diarrhoea (CDAD). Furthermore, approximately 4.7 percent of hospitalised patients had CDAD, which is greater than the rates reported in developed countries. Notably, 28% of the isolates were C. difficile A⁺/B^-/GDH^-, which only possesses tcdA genes but does not produce toxin