Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan

Introduction An increase in the incidence of Clostridium difficile infection (CDI) in Western countries has come to prominence over the last 15 years. However awareness and surveillance of CDI in Asia remained poor with epidemiological data being scanty in Asia and in particular Malaysia. CDI is...

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Main Author: Zainul, Nadiah Hanim
Format: Thesis
Language:English
Published: 2016
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Online Access:http://eprints.usm.my/43130/1/Dr._Nadiah_Hanim_Zainul-24_pages.pdf
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id my-usm-ep.43130
record_format uketd_dc
institution Universiti Sains Malaysia
collection USM Institutional Repository
language English
topic RA643-645 Disease (Communicable and noninfectious) and public health
spellingShingle RA643-645 Disease (Communicable and noninfectious) and public health
Zainul, Nadiah Hanim
Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
description Introduction An increase in the incidence of Clostridium difficile infection (CDI) in Western countries has come to prominence over the last 15 years. However awareness and surveillance of CDI in Asia remained poor with epidemiological data being scanty in Asia and in particular Malaysia. CDI is commonly associated with nosocomial infections, but community acquired CDI has been reported with increasing frequency lately. Despite the increase in incidence and severity of CDI, a recent survey found awareness of CDI being poor, with underestimation of its contribution to antibiotic-associated disease and recurrence rates. Objective We aimed to explore the prevalence and associated risk factors of CDI in hospitalized patients in HUSM. We also aimed to explore the carriage rate among the elderly in the community in Kelantan. Finally we aimed to determine the level of awareness of CDI among staff and students in HUSM. Methodology This study is divided into 3 arms. For the hospital arm, it was a prospective cross sectional study of CDI prevalence among 76 hospitalized patients in HUSM from 1st April 2015 until 30th September 2015. For the community arm, it was a cross sectional study of C. difficile carrier prevalence among 138 elderlies from the community in Kelantan from July 2015 to September 2015.For both arms, stools were tested for C. difficile antigen and toxin detection using C. DIFF QUIK CHEK COMPLETE®. The samples were then sent to Western Australia for culture and PCR for toxin genes and ribotyping for molecular epidemiology. For the awareness survey, it was a cross sectional study of C. difficile awareness among 154 participants comprised of HUSM staff and students during an awareness campaign for C. difficile in HUSM on 6th August 2015. Data was obtained thru a self-administered questionnaire which was based from a previous international internet-based awareness study. Result For the hospital arm, 20 samples (26.3%) were positive for C. difficile antigen (CDifAg), 7 samples (9.2%) were positive for C. difficile toxin (CDifToxin) and 19 samples (25%) were positive from direct culture. Significant ribotype diversity with six distinct ribotype groups (QX001, UK 017, QX 002, QX 107, QX 117 and QX 463) were identified. Charlson Comorbidity Index, urea, creatinine, albumin and CRP level, duration of hospitalization, use of antibiotics, use of chemotherapy, underlying medical illness and fulminant severity were significantly associated with CDI using Simple Logistic Regression (P-value < 0.25). Further analysis with Multiple Logistic Regression showed significant association between CDI with age, duration of hospitalization and use of antibiotics (P-value < 0.05). For the community arm, 2 samples (1.6%) were positive for both CDifAg and direct culture while negative for CDifToxin. Ribotying of the 2 samples showed unknown strain. From the study, it was found that the study population did not have high PPI and antibiotics use which were known CDI risk factors. For awareness study arm, there was a low level of awareness on CDI with only 2.6% of 154 respondents able to correctly answer all questions correctly. Ironically a large proportion of the participants (n = 73; 47.4%) considered C. difficile to be overestimated in their current practise. There was no significant association between level of awareness on CDI with age, gender and occupation i.e. being a clinician. Conclusion In conclusion, this study demonstrated that the prevalence rate for CDI in hospitalized patients in HUSM were 26.3% for CDifAg, 9.2% for CDifToxin and 25% for direct culture with 6 distinct ribotype strains; QX001, UK 017, QX 002, QX 107, QX 117 and QX 463 identified. Independent risk factors for CDI were age, duration of hospitalization and use of antibiotics. The carrier rate for C. difficile was 1.6% among the elderly in the community with unknown strain identified from PCR ribotyping. Low usage of PPI and antibiotics were seen in our study population and could explain the low prevalence rate of CDI in our study population. Low awareness on CDI was seen among healthcare professionals in HUSM which was also seen internationally. Therefore CDI being an underdiagnosed and under recognised issue in the healthcare system is an issue that needs to be addressed by all parties.
format Thesis
qualification_level Master's degree
author Zainul, Nadiah Hanim
author_facet Zainul, Nadiah Hanim
author_sort Zainul, Nadiah Hanim
title Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
title_short Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
title_full Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
title_fullStr Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
title_full_unstemmed Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan
title_sort prevalance and molecular epidemiology of clostridium difficile infection in hospital universiti sains malaysia patients and elderly community subjects in kelantan
granting_institution Universiti Sains Malaysia
granting_department Pusat Pengajian Sains Perubatan
publishDate 2016
url http://eprints.usm.my/43130/1/Dr._Nadiah_Hanim_Zainul-24_pages.pdf
_version_ 1747821170662572032
spelling my-usm-ep.431302019-04-12T05:25:33Z Prevalance and molecular epidemiology of clostridium difficile infection in Hospital Universiti Sains Malaysia patients and elderly community subjects in Kelantan 2016 Zainul, Nadiah Hanim RA643-645 Disease (Communicable and noninfectious) and public health Introduction An increase in the incidence of Clostridium difficile infection (CDI) in Western countries has come to prominence over the last 15 years. However awareness and surveillance of CDI in Asia remained poor with epidemiological data being scanty in Asia and in particular Malaysia. CDI is commonly associated with nosocomial infections, but community acquired CDI has been reported with increasing frequency lately. Despite the increase in incidence and severity of CDI, a recent survey found awareness of CDI being poor, with underestimation of its contribution to antibiotic-associated disease and recurrence rates. Objective We aimed to explore the prevalence and associated risk factors of CDI in hospitalized patients in HUSM. We also aimed to explore the carriage rate among the elderly in the community in Kelantan. Finally we aimed to determine the level of awareness of CDI among staff and students in HUSM. Methodology This study is divided into 3 arms. For the hospital arm, it was a prospective cross sectional study of CDI prevalence among 76 hospitalized patients in HUSM from 1st April 2015 until 30th September 2015. For the community arm, it was a cross sectional study of C. difficile carrier prevalence among 138 elderlies from the community in Kelantan from July 2015 to September 2015.For both arms, stools were tested for C. difficile antigen and toxin detection using C. DIFF QUIK CHEK COMPLETE®. The samples were then sent to Western Australia for culture and PCR for toxin genes and ribotyping for molecular epidemiology. For the awareness survey, it was a cross sectional study of C. difficile awareness among 154 participants comprised of HUSM staff and students during an awareness campaign for C. difficile in HUSM on 6th August 2015. Data was obtained thru a self-administered questionnaire which was based from a previous international internet-based awareness study. Result For the hospital arm, 20 samples (26.3%) were positive for C. difficile antigen (CDifAg), 7 samples (9.2%) were positive for C. difficile toxin (CDifToxin) and 19 samples (25%) were positive from direct culture. Significant ribotype diversity with six distinct ribotype groups (QX001, UK 017, QX 002, QX 107, QX 117 and QX 463) were identified. Charlson Comorbidity Index, urea, creatinine, albumin and CRP level, duration of hospitalization, use of antibiotics, use of chemotherapy, underlying medical illness and fulminant severity were significantly associated with CDI using Simple Logistic Regression (P-value < 0.25). Further analysis with Multiple Logistic Regression showed significant association between CDI with age, duration of hospitalization and use of antibiotics (P-value < 0.05). For the community arm, 2 samples (1.6%) were positive for both CDifAg and direct culture while negative for CDifToxin. Ribotying of the 2 samples showed unknown strain. From the study, it was found that the study population did not have high PPI and antibiotics use which were known CDI risk factors. For awareness study arm, there was a low level of awareness on CDI with only 2.6% of 154 respondents able to correctly answer all questions correctly. Ironically a large proportion of the participants (n = 73; 47.4%) considered C. difficile to be overestimated in their current practise. There was no significant association between level of awareness on CDI with age, gender and occupation i.e. being a clinician. Conclusion In conclusion, this study demonstrated that the prevalence rate for CDI in hospitalized patients in HUSM were 26.3% for CDifAg, 9.2% for CDifToxin and 25% for direct culture with 6 distinct ribotype strains; QX001, UK 017, QX 002, QX 107, QX 117 and QX 463 identified. Independent risk factors for CDI were age, duration of hospitalization and use of antibiotics. The carrier rate for C. difficile was 1.6% among the elderly in the community with unknown strain identified from PCR ribotyping. Low usage of PPI and antibiotics were seen in our study population and could explain the low prevalence rate of CDI in our study population. Low awareness on CDI was seen among healthcare professionals in HUSM which was also seen internationally. Therefore CDI being an underdiagnosed and under recognised issue in the healthcare system is an issue that needs to be addressed by all parties. 2016 Thesis http://eprints.usm.my/43130/ http://eprints.usm.my/43130/1/Dr._Nadiah_Hanim_Zainul-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan