Abstract

Background: Clostridium difficile is a frequently identified cause of nosocomial gastrointestinal disease. It has been proved to be a causative agent in antibiotic-associated diarrhea. Aims: This study was aimed to determine the prevalence and risk factors of Clostridium difficile-associated diarrhea (CDAD) in hospitalized patients with nosocomial diarrhea in Zahedan, Iran. Methods: In this study from June to December 2014, a total of 100 stool samples of patients with nosocomial antibiotic associated diarrhea that were admitted in to the intensive care units (ICUs) (50), surgery (20) and internal medicine wards (30) in Emam Ali hospital, Zahedan, Iran were collected. All stool samples were analyzed by cytotoxicity assay and enzyme immune assay for detection and conformation of toxins. Results: The mean +/- standard deviation of age was 40.4 +/- 11.8 and 75 (61.5) of patients were male. Nine (7.4) cases of nosocomial diarrhea were diagnosed as CDAD that all isolates were toxigenic. Five of 65 organs receive transplant patients and 4/41 hospitalized patients in ICUs ward were developed CDAD. None of samples that obtained from surgery ward infected with C. difficile. Ceftazidime and Ampicilline-Sulbactam were the most common antimicrobial drugs used. Multivariate analysis showed that use of diapers, antibiotic and immunosuppressive therapies were significantly associated with CDAD (P < 0.05). Conclusions: Hospital transmission of C. difficile commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD.