Clostridium Difficile Infection Detection And Etiology

Objective: The research of Clostridium difficile infection in detecting and surveillance was still in the primary stage.This purposes of this study are as follows: Investigating the different methods in dectecting CDI. Exploring the association of community-acquired Clostridium difficile infection and acid suppression drugs by meta-analysis.Exploring the dectection methods of CDI and the association between CDI and clinical etiology,so as to guide clinicians in identifying CDI and control the CDI in the community and medical institutions.Methods: 1.Collecting stool samples in Ren Ji Hospital from September 2014 to March 2015 and analyzed for C.difficile via C.difficile culture and toxin test(ELFIA).Comparing the results of two methods by PCR.2.We searched relevant articles from PUBMED, EMBASE, Web of Knowledge. Databases were from inception to October 2014. Studies were selected using specific inclusion and exclusion criteria. A systematic review and meta-analysis was performed on the association between community-associated Clostridium difficile infection and acid suppression drugs.Results: 1.A total of 293 samples of diarrhea stool patients and 29 samples(9.9%) of toxin postive were dectected.The cases of <35y were 8(27.5%),35-65 y were 14(48.3%,OR 1.46 95%CI 0.59-3.62),65 y were 7(24.2%,OR 2.08 95%CI 0.71-6.08) and female were 19(65.6%,OR 4.0,95%CI 1.79-8.98). A total of 138 samples of diarrhea stool patients and 21 samples(15.2%) of C.difficile were cultured. The cases of <35y were 8(38.1%),35-65 y were 12(57.1%,OR 1.46 95%CI 0.48-3.44),65y were 1(4.8%,OR 0.20 95%CI 0.02-1.71) and female were 12(57.1%,OR2.77,95%CI 1.08-7.15).2.The toxin A/B of 26 samples of C.difficile were detected by PCR.The cases of tcd A(+)/tcd B(+) were 7,tcd A(-)/tcd B(+) were 18 and tcd A(-)/tcd B(-) was one.The 15 toxin postive samples all dectected tcd A/B,but only one toxin negetive sample did not dectct tcd A and tcd B in 10 samples.3.Seven studies(n=110712) were included in final review. PPI therapy increased the risk for CA-CDI(odds ratio, 1.76, 95% CI, 1.45–2.4,P<0.00001,I2=0), H2 RA therapy increased the risk for CA-CDI(odds ratio, 2.08, 95% CI, 1.50–2.90,P<0.00001,I2=79).Conclusions: 1.The postive rate of C. difficile culture was higher than ELFIA.The association between gender female and advanced age with CDI.2.Toxin test(ELFIA) had the high specificity,but the lower sensitive compared with C. difficile culture.3. Acid suppression therapy was an important risk factor for CA-CDI. We observed PPI and H2 RA therapy were associated with about a 2-fold increase in risk for CA-CDI. Therefore, Acid suppression therapy could be an absolute risk factor for Clostridium difficile infection, which might play an important role in clinical treatment.