Study on utility of GDH and prevalence of Clostridium difficile infection in ICU patients

Abstract

Background

Clostridium difficile (C difficile) is one of the leading causes of nosocomial diarrhea in developing countries. It is a commonly encountered infection in the ICU setting where critically ill patients are at significant risk. The aim of this study was to study the clinical and microbiological profile of Clostridium Difficile Infection (CDI) in intensive care unit (ICU) settings of a Tertiary Care Hospital with the primary objective to find out the prevalence of C difficile diarrhea among the patients and the secondary objective to find out the utility of Glutamate Dehydrogenase (GDH) in screening for such patients.

Methods

This was a single center, prospective, diagnostic study conducted from July to Dec 2023. The study was carried out after obtaining clearance from the Institute Ethics Committee. As per a 2017 study done by Segar et al, keeping the tolerable error as 1.5 at 95% confidence interval, minimum sample size was found to be 200.

Results

The prevalence of CDI among ICU patients was 6% and among diarrheic patients the prevalence was 20%. GDH showed a sensitivity and specificity of 100% with all cuture positive cases of CDI also showing GDH positivity. The length of ICU and hospital stay among CDI patients (28±17 days/56±17 days) was significantly longer compared to non CDI patients (11 ± 06 days/26 ± 18 days) (p-0.003). The overall hospital mortality among ICU patients with CDI patients was 33% as compared with 25% among those without CDI thus showing a statistically significant difference in mortality risk (p-0.030).

Conclusion

It is concluded that there is a need for additional prevention and treatment studies in this setting. No correlation could be established between the choice or duration of antibiotic therapy and the development of CDI. Similarly no correlation could be established between the primary diagnosis for admission of the patient and development of CDI.