Rodríguez-Cavallini E, Gamboa-Coronado MM, Camacho-Mora Z, Herrera ML

Language: Spanish
References: 31
Page: 13-20
PDF size: 80.46 Kb.

ABSTRACT

Introduction. C. difficile and C. perfringens are important etiological agents of antibiotic associated diarrhea in adults and children worldwide, including Costa Rica. We intend to expand on previous research by including hospitalized patients over 60 years, to evaluate their additional factors and more severe illnesses.
Materials and Methods. Over an 18 month period 51 samples of diarrheic feces were screened and cultured for C. difficile and C. perfringens enterotoxins. Every isolate was evaluated for toxin production and antibiotic susceptibility.
Results. C. difficile toxin A was detected in 12 samples (24%) and C. perfringens enterotoxin in 10 (20%). C. difficile was isolated from 6 samples (12%) and C. perfringens from 16 (31%). All C. difficile isolates and only two C. perfringens were toxigenic, but both agents were isolated from two samples. Every C. difficile isolate was sensitive to beta-lactam, chloramphenicol and metronidazole, but most were resistant to clindamycin. A high percentage of C. perfringens strains showed resistance to beta lactam antibiotics, chloramphenicol and metronidazole and like C. difficile, also clindamycin.
Conclusions. According to toxin detection in feces, C. difficile and C. perfringens were the etiological agents in 44% of the diarrhea cases, reinforcing the need to consider both agents for diagnosis of diarrhea in hospitalized elderly patients. Clindamycin resistance shown by many isolates should be noted, since it has been implicated as a risk factor for the development of diarrhea. Metronidazole may not be the best choice, since 25% of C. perfringens strains were also resistant to this drug.

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