Prevalence ofClostridium difficileinfection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia

Abstract

SUMMARYLittle is known aboutClostridium difficileinfection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage ofC. difficileamong the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n= 76) and healthy community members (n= 138),C. difficileantigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenicC. difficilecolonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22C. difficilestrains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis,C. difficilecolonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (bothP< 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey.C. difficilecolonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.