The investigation of toxin-producing Clostridium difficile and Candida albicans in the patients with antibiotic-associated diarrhea _West China Medical Journal

Authors：

LONG Haiyan ¹ ,  FENG Ping ²

1. West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Infectious Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FENG Ping, Email: fengp_62@163.com

Keywords：

Antibiotic-associated diarrhea; Toxin-producing Clostridium difficile; Candida albicans

DOI：

10.7507/1002-0179.201610067

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Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A⁺B⁺, type A^-B⁺, and type A⁺B^- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.

Citation： LONG Haiyan, FENG Ping. The investigation of toxin-producing Clostridium difficile and Candida albicans in the patients with antibiotic-associated diarrhea . West China Medical Journal, 2018, 33(5): 555-560. doi: 10.7507/1002-0179.201610067 Copy

1.	Gorkiewicz G. Nosocomial and antibiotic-associated diarrhoea caused by organisms other than Clostridium difficile. Int J Antimicrob Agents, 2009, 33(3): S37-S41.
2.	Gupta TP, Ehrinpreis MN. Candida-associated diarrhea in hospitalized patients. Gastroenterology, 1990, 98(3): 780-785.
3.	Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile. Clin Infect Dis, 2012, 55(7): 982-989.
4.	Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med, 2015, 372(9): 825-834.
5.	Kelly CP, Lamont JT. Clostridium difficile: more difficult than ever. N Engl J Med, 2008, 359(18): 1932-1940.
6.	Goorhuis A, Bakker D, Corver J, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis, 2008, 47(9): 1162-1170.
7.	Collins DA. Hawkey PM, Riley TV. Epidemiology of Clostridium difficile infection in Asia. Antimicrob Resist Infect Control, 2013, 2(1): 21.
8.	Dong DF, Peng YB, Zhang LH, et al. Clinical and microbiological characterization of Clostridium difficile infection in a tertiary care hospital in Shanghai, China. Chin Med J (Engl), 2014, 127(9): 1601-1607.
9.	Huang H, Wu S, Wang M, et al. Molecular and clinical characteristics of Clostridium difficile infection in a University Hospital in Shanghai, China. Clin Infect Di, 2008, 47(12): 1606-1608.
10.	陈伟, 刘文恩, 简子娟, 等. 艰难梭菌临床分离株病原学和分子流行病学及临床特征分析. 中华检验医学杂志, 2014(11): 855-860.
11.	Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol, 2013, 108(4): 478-498.
12.	Cadena J, Thompson IG, Patterson JE, et al. Clinical predictors and risk factors for relapsing Clostridium difficile infection. Am J Med Sci, 2010, 339(4): 350-355.
13.	Bartlett JG. Clostridium difficile: progress and challenges. Ann N Y Acad Sci, 2010, 1213(1): 62-69.
14.	Winstrom J, Norrby SR, Myhre EB, et al. Frequency of antibiotic associated diarrhea in 2642 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother, 2001, 47(1): 43-50.
15.	van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med, 2013, 368(5): 407-415.
16.	Nkuo-Akenji TK, Ndip RN, Ntoko FA. The prevalence of Candida albicans-associated diarrhoea in Buea, South West Cameroon. Afr J Health Sci, 2002, 9(3/4): 153-157.
17.	张爱红, 孙素芹, 刘阳, 等. 肠道菌群失调与广谱抗生素应用的相关性分析. 华北煤炭医学院学报, 2006, 8(5): 619-620.
18.	Leroy O, Gangneux JP, Montravers P, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med, 2009, 37(5): 1612-1618.
19.	Popiel KY, Wong P, Lee MJ, et al. Invasive saccharomyces cerevisiae in a liver transplant patient: case report and review of infection in transplant recipients. Transpl Infect Dis, 2015, 17(3): 435-441.
20.	Al-Sweih N, Khan ZU, Ahmad S, et al. Kodamaea ohmeri as an emerging pathogen: a case report and review of the literature. Med Mycol, 2011, 49(7): 766-770.

1. Gorkiewicz G. Nosocomial and antibiotic-associated diarrhoea caused by organisms other than Clostridium difficile. Int J Antimicrob Agents, 2009, 33(3): S37-S41.
2. Gupta TP, Ehrinpreis MN. Candida-associated diarrhea in hospitalized patients. Gastroenterology, 1990, 98(3): 780-785.
3. Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile. Clin Infect Dis, 2012, 55(7): 982-989.
4. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med, 2015, 372(9): 825-834.
5. Kelly CP, Lamont JT. Clostridium difficile: more difficult than ever. N Engl J Med, 2008, 359(18): 1932-1940.
6. Goorhuis A, Bakker D, Corver J, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis, 2008, 47(9): 1162-1170.
7. Collins DA. Hawkey PM, Riley TV. Epidemiology of Clostridium difficile infection in Asia. Antimicrob Resist Infect Control, 2013, 2(1): 21.
8. Dong DF, Peng YB, Zhang LH, et al. Clinical and microbiological characterization of Clostridium difficile infection in a tertiary care hospital in Shanghai, China. Chin Med J (Engl), 2014, 127(9): 1601-1607.
9. Huang H, Wu S, Wang M, et al. Molecular and clinical characteristics of Clostridium difficile infection in a University Hospital in Shanghai, China. Clin Infect Di, 2008, 47(12): 1606-1608.
10. 陈伟, 刘文恩, 简子娟, 等. 艰难梭菌临床分离株病原学和分子流行病学及临床特征分析. 中华检验医学杂志, 2014(11): 855-860.
11. Surawicz CM, Brandt LJ, Binion DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol, 2013, 108(4): 478-498.
12. Cadena J, Thompson IG, Patterson JE, et al. Clinical predictors and risk factors for relapsing Clostridium difficile infection. Am J Med Sci, 2010, 339(4): 350-355.
13. Bartlett JG. Clostridium difficile: progress and challenges. Ann N Y Acad Sci, 2010, 1213(1): 62-69.
14. Winstrom J, Norrby SR, Myhre EB, et al. Frequency of antibiotic associated diarrhea in 2642 antibiotic-treated hospitalized patients: a prospective study. J Antimicrob Chemother, 2001, 47(1): 43-50.
15. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med, 2013, 368(5): 407-415.
16. Nkuo-Akenji TK, Ndip RN, Ntoko FA. The prevalence of Candida albicans-associated diarrhoea in Buea, South West Cameroon. Afr J Health Sci, 2002, 9(3/4): 153-157.
17. 张爱红, 孙素芹, 刘阳, 等. 肠道菌群失调与广谱抗生素应用的相关性分析. 华北煤炭医学院学报, 2006, 8(5): 619-620.
18. Leroy O, Gangneux JP, Montravers P, et al. Epidemiology, management, and risk factors for death of invasive Candida infections in critical care: a multicenter, prospective, observational study in France (2005-2006). Crit Care Med, 2009, 37(5): 1612-1618.
19. Popiel KY, Wong P, Lee MJ, et al. Invasive saccharomyces cerevisiae in a liver transplant patient: case report and review of infection in transplant recipients. Transpl Infect Dis, 2015, 17(3): 435-441.
20. Al-Sweih N, Khan ZU, Ahmad S, et al. Kodamaea ohmeri as an emerging pathogen: a case report and review of the literature. Med Mycol, 2011, 49(7): 766-770.

West China Medical Journal

The investigation of toxin-producing Clostridium difficile and Candida albicans in the patients with antibiotic-associated diarrhea

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