Study of Clostridioides difficile associated diarrheain Acute care areas of atertiary care centre in Western Rajasthan-a prospective study
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Purpose The aim of this study is to identify Clostridioides difficile associated diarrhoea (CDAD) in patients admitted to acute care units of the hospital. It also examines different detection methods, including anaerobic culture, GDH assay, and Toxin A/B ELISA, while exploring how the infection relates to patient risk factors and clinical features. Materials and Method Cross sectional study conducted in the Department of microbiology over 2 years. Patients >1 year of age, who were admitted and passing atleast 3 unformed stool over 24 hours, with history of taking antibiotics were included in the study. Stool samples from the included patients were collected, with one part used for anaerobic culture and another part for serological testing using Glutamate Dehydrogenase (GDH) ELISA and Toxin A/B ELISA for C. difficile. Identification of isolates was performed using MALDI-TOF MS. The results were analysed using statistical methods. Result Out of 180 suspected cases of Antibiotic Associated Diarrheal (AAD), 95(52.8%) were males. Maximum cases were in age group, above 60 years (27.8%) & 51 to 60 years (15.6%). Out of the 180 samples, GDH ELISA was positive in 29 (16%) cases, however Toxin A/B ELISA was positive in 5 (2.8%) samples. Thus, the prevalence of CDAD was found to be 2.8%. Isolation of Clostridioides difficile from culture was in 3 (1.7%) cases. 80% of confirmed CDAD cases were received more than one antibiotics. The median antibiotic duration among CDAD cases was 14 days (IQR = 9). All CDAD cases had a history of consumption of BL-BLI antibiotics, while 40% were on Meropenem, and 20% were on Ceftriaxone and Levofloxacin antibiotics. A possible association between abdominal surgery and CDAD was also noted in the study. Mortality rate in confirmed CDAD cases was 60%. Conclusion This study in Western Rajasthan underscores the paramount importance of early CDAD detection and management to forestall fatal complications and mortality in critically ill patients, while fostering prudent antibiotic utilization and fortifying antimicrobial stewardship practices in hospital setting.
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Many thanks for the authors for sharing their work. While the manuscript has improved substantially from the initial submission, your paper focuses on a too small number of cases and the way in which statistics are being presented are misleading, because of this small number. Additionally, I cannot see the manuscript being favoured in peer review because of this major limitation and the language still requires significant work. Access Microbiology aims to publish research that is sound, and while your research is sound, results are lacking. I hope this does not dissuade you from future submissions.
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Many thanks for authors for their submission. However, in the current state I do not think your manuscript is suitable for peer-review. I am going to provide some suggestions which you may incorporate to strengthen your manuscript and consider re-submission. Firstly, your manuscript requires a thorough proof-read for widespread grammatical errors throughout. Please review your ‘Proof’ copy prior to approving the submission. There are quite a number of errors with spacing, sentence syntax, spelling, capitalisation and italicisation. Please correct. Additionally, abbreviations are used in the manuscript without being named initially. Your abstract describes a surveillance study, for Clostridioides difficile infection among patients admitted with presumed antimicrobial associated diarrhoea. The Abstract can be better developed, in …
Many thanks for authors for their submission. However, in the current state I do not think your manuscript is suitable for peer-review. I am going to provide some suggestions which you may incorporate to strengthen your manuscript and consider re-submission. Firstly, your manuscript requires a thorough proof-read for widespread grammatical errors throughout. Please review your ‘Proof’ copy prior to approving the submission. There are quite a number of errors with spacing, sentence syntax, spelling, capitalisation and italicisation. Please correct. Additionally, abbreviations are used in the manuscript without being named initially. Your abstract describes a surveillance study, for Clostridioides difficile infection among patients admitted with presumed antimicrobial associated diarrhoea. The Abstract can be better developed, in particular I am unsure how your Results allowed you to draw such a Conclusion without any supporting data on the mortality or even morbidity of your patients with C diff infection; especially with such a small number of positive samples. Your major Result is the prevalence of 2.8% and I am unsure how that result was clarified. If the Result section was better structured, you could say that prevalence was found to be 2.8% which relied on C diff infections being confirmed by… Or any sort of statement to justify this Result. I know this is stated in the Results, but it will be important to validate your statements from the start. For your Highlights, you mentioned the all-cause mortality rate is high, yet why was this value not quoted in your Abstract? Similarly, you mention a possible association with abdominal and genitourinary surgery with C diff infection, yet data is absent in the Abstract. Your Introduction need a proof read. Numerous grammatical errors, and your entire Introduction could be re-worded and re-structured to really convey the significance of C diff infection and its associated morbidity and mortality. Regarding treatment options, it would be important to contextualise your own setting by stating what is used for treatment at your centre and which Guidelines influence local policies. The role of infection prevention and control could also have been explored. You mentioned that stool samples were cultured on anaerobic basal and selective media like… Which agar was used for the study samples? Were different ones utilised? In that case your results are not comparable, because the yield of C diff is not equal across all those mentioned agars. In your Results, you are reporting statistical significance among 5 C diff cases. This number is incredibly low and not powered to show any real significance. This is a major limitation in your findings and should be acknowledged before quoting p values. Your Results also need to be better presented. At the moment it is very hard to decipher between your antimicrobial associated diarrhoea and then your C diff infections; which to me is a bit counter-intuitive as your aim was to explore C diff infections, in terms of prevalence and epidemiological data – so why are you reporting on the non-C diff diarrhoeal cases. If you want to mention them, fine but more concisely and preface your rationale for including the data. Your data on antimicrobials is interesting, but again lost between your descriptions of antimicrobial associated diarrhoea and then C diff. Restructure. Was any data collected on antimicrobial durations? No data was mentioned on treatment of C diff. Were any cases treated? What was the turn around times for the results? Were cases clinically assessed for severe C diff? Your Discussion needs more referencing. Statements are being made without appropriate referencing. It also needs a significant proof-read for grammatical errors. You compared your data with the Literature and included a fair bit of studies so that is commendable, however your execution of the comparisons required much more work. Overall, your study is interesting but with the small sample size you really need your paper to read well and present your data in an interesting way, which at present it does not. I do not wish to dissuade you but your paper requires a significant re-write before consideration for peer-review. I hope my comments can be of some benefit, please do not hesitate to reach out if I can be of further assistance.
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