Prevalence of toxigenic Clostridium difficile in hospitalized patients in the southwestern province of Saudi Arabia: Confirmation using the GeneXpert analysis

ABSTRACT

Clostridium difficile (Clostridioides difficile) is a leading cause of nosocomial infections in hospitalized patients worldwide. Stool samples were collected from 112 inpatients admitted to different hospitals and were screened for C. difficile GDH + toxin A + B by immunoassay, and all positive samples by immunoassay were processed for molecular detection of C. difficile using the GeneXpert assay. C. difficile strains were detected in 12 (10.71%) out of 112 stool samples using the GDH + toxin A + B immunoassay method and toxigenic C. difficile was confirmed in 5 stool samples using the GeneXpert molecular assay. C. difficile strains were also detected in 7 (8.97%) out of 78 stool samples from intensive care unit patients, 3 (25%) out of 12 stool samples from internal medicine ward patients, 1 (11.11%) out of 9 stool samples from surgery ward patients, and 1 (10%) out of 10 stool samples from isolation ward patients using the GDH + toxin A + B immunoassay method and the toxigenic C. difficile strain was confirmed in 1, 2, 1, and 1 stool samples, respectively, using the GeneXpert molecular assay. Toxigenic C. difficile was confirmed in patients at 4 (51.14%) out of 7 hospitals. In the present study, we also analyzed the clinical information of patients with C. difficile-positive stool samples who were receiving one or more antibiotics during hospitalization. The binary toxin gene (cdt), the tcdC gene, and the C. difficile strain polymerase chain reaction (PCR) ribotype 027 were not detected using the GeneXpert molecular assay among 12 C. difficile-positive samples by immunoassay. This study should aid in the prevention of unnecessary empiric therapy and increase the understanding of the toxigenic C. difficile burden on the healthcare system in the southwestern province of Saudi Arabia.

KEYWORDS:

• Toxigenic and nontoxigenic Clostridium difficile
• nosocomial infection
• Clostridioides difficile
• GeneXpert Molecular assay
• Immunoassay for C. difficile

Acknowledgments

We thank the dean and the staff of the Faculty of Applied Medical Sciences for their cooperation and help in conducting this research.

We also thank Lalitha Shree Basode, Data analyst, Zarb School of Business, Hofstra University, Hofstra, New York, USA for data analysis.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Abbreviations

GDH	=	glutamate dehydrogenase
RT027	=	ribotype 027
tcdC	=	one-base pair deletion at nucleotide position 117 within the gene encoding the negative regulator of toxin production
tcdB	=	toxin B gene
cdt	=	binary toxin gene
PaLoc	=	pathogenicity locus
CDI	=	Clostridium difficile infection
SPC	=	sample processing control
ICU	=	intensive care unit
UK	=	United Kingdom

Availability of data and materials

All the data supporting the conclusion are available in Tables 1, 2 and 3.

Authors contributions

Conceptualization, methodology, software, validation, and writing: VKB and NK; resources, investigation, review, and editing: AA, AMM, and MUA; investigation and sample collection: KAMZ and AHAG. All authors read and approved the final manuscript.

Ethics approval and consent to participate

This study was approved by the Deanship of Scientific Affairs and Research, Jazan University, Jazan, Saudi Arabia. Informed written consent was obtained from all participants in the study before sample collection.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The authors would like to thank the Deanship of Scientific Research, Jazan University. This research is part of the research group funding program at Jazan University. The authors would like to thank the Vector-Borne Diseases Research Group, Grant No. RG-2-1.