ABSTRACT

Background: Clostridioides difficile is a spore-forming Gram-positive anaerobic bacillus and an important cause of healthcare-associated diarrhea. It ranges in severity from mild diarrhea to pseudomembranous colitis, toxic megacolon, and sepsis. Although CDI has been widely studied in developed countries, limited data are available from South India, particularly Tamil Nadu.

Objectives: This study aimed to (i) estimate the prevalence of CDI among symptomatic patients, (ii) assess associated risk factors, and (iii) evaluate the relationship between broad-spectrum antibiotic use and CDI.

Methods: A retrospective observational study was conducted at a tertiary care hospital in Madurai between January 2021 and December 2022. All liquid stool samples submitted for CDI testing were included, excluding duplicates. Samples were screened using a qualitative immunochromatographic assay for glutamate dehydrogenase (GDH) and toxins A/B. Data were analyzed using SPSS; categorical variables were expressed as frequencies and percentages, while continuous variables were reported as mean ± SD.

Results: Out of 330 stool samples tested, 55 (16.6%) were positive for CDI. Males comprised 56.4% of cases. The majority of them belong to the pediatric age group (25.5%) between 2 and 12 years. Most patients were admitted under Hemato-oncology (58.2%) and ICUs (25.4%). Prior proton pump inhibitor use was reported in 92.7%. 78.2% had malignancy or were receiving immunosuppressive therapy. The mean hospital stay was 19.73 ± 13.24 days. Meropenem (61.8%) and third-generation cephalosporins (34.5%) were the most frequently used antibiotics, with meropenem significantly associated with CDI (p=0.001). Nearly half (49.1%) developed CDI within one week of antibiotic initiation. Clinical outcomes showed 76.4% discharged in good condition, while 7.3% mortality occurred predominantly among patients with hematological malignancy. Treatment most commonly involved oral vancomycin plus metronidazole (56.3%), followed by metronidazole monotherapy (30.9%).

Conclusion: The prevalence of CDI in our center was 16.6% in 2021-22. Major risk factors included antibiotic exposure, PPI use, malignancy, and immunosuppression. Meropenem was most strongly associated with CDI. While combination therapy was frequently prescribed, vancomycin monotherapy remains the standard of care. These findings highlight the burden of CDI in one of the Southern India healthcare facilities.