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- Title
Hastanede yatan ishalli hastaların dışkı örneklerinde Clostridium difficile toksin araştırılması ve risk faktörlerinin incelenmesi.
- Authors
KOSTUL, Hande; DELİALİOĞLU, Nuran; ŞAHİN-HORASAN, Elif; EMEKDAŞ, Gürol; ÖZTÜRK, Candan; KUYUCU, Necdet
- Abstract
Objective: The diarrhea related with the Clostridium difficile is seen especially in the patients hospitalized and using broad spectrum antibiotics. Pathogenic strains of C. difficile produce two exotoxins, toxin A and toxin B, which cause colonic mucosal injury and inflammation. It is possible to observe a clinical picture ranging from a mild self-limiting diarrhea to severe course of pseudomembranous enterocolitis. Besides antibiotic intake; advanced age, gastrointestinal endoscopy, presence of a nasogastric tube, receiving anti-ulcer medication, severe underlying illness, immunosuppression, intensive care unit and prolonged hospital stay are considered as other risk factors. The accurate diagnosis is established by producing C. difficile from the feces and demonstration of the toxin by determining the cytopathic effect in cell culture production. Since, this is not always possible in routine practice, demonstration of the toxin with enzyme immunoassay is a method used more often. The aim of this study was to investigate the intestinal flora from stool specimens of hospitalized patients and patients having diarrhea, existence of C. difficile toxin A and B and to determine the related risk factors. Method: Stool specimens of 158 diarrhea patients hospitalized in various clinics which were sent to Department of Medical Microbiology Laboratory from Mersin University Medical Faculty Hospital between September 2010 and October 2011 were included in this study. Toxin A/B of C. difficile were investigated in the stool specimens of these patients with Enzyme-Linked Fluorescent Assay (ELFA) method. In addition, these samples were examined microscopically and routine bacteriological cultures were done. Results: As a result of this study, C. difficile toxin A/B is found as positive in 18 (11,4%) patients and 15 of these patients (83,3%) had used, beta-lactam - betalactamase inhibitor group (penicillins, cephalosporins, and carbapenems) antibiotics. One of the toxin positive patients had Candida albicans while normal intestinal flora bacteria were grown in 17 of them. Using of penicillin was found to be statistically significant among the various risk factors studied in toxin positive and toxin negative patients. Conclusion: C. difficile should be considered as the main cause of diarrhea particularly occured in patients hospitalized and used antibiotics. For this purpose, tests which has high sensitivity and specificity may be used for rapid diagnosis of A and B toxins in stool samples. As a result, early detection of toxin positive cases will provide initiation of specific therapy and the implementation of effective infection control measures.
- Publication
Turkish Bulletin of Hygiene & Experimental Biology / Türk Hijyen ve Deneysel Biyoloji, 2015, Vol 72, Issue 3, p183
- ISSN
0377-9777
- Publication type
Article
- DOI
10.5505/TurkHijyen.2015.36024