الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 84 |  |  |
| | | from | 84 | | |
Abstract
Since 2000, C. difficile infections (CDIs) have emerged as a major public health problem and outbreaks of CDI have been described worldwide, however the burden of CDIs in the ICUs and its impact on patient outcome in Egypt is lacking.This study was designed to identify the role of C. difficile associated diarrhea (CDAD) in the ICUs of Alexandria University Hospitals, estimate C. difficile colonization in infants below 2 years of age hospitalized in the NICU and Pediatric wards of El-Shatby University Hospitals and verify the toxigenic potential of C difficile isolates.
To fulfill the primary aim of the present study surveillance was carried out in one Pediatric ICU (PICU) and 4 General ICUs. All patients admitted to the selected ICUs were monitored for the development of symptoms of HAD. Subsequently stool samples were collected from diarrheic patients fulfilling the inclusion criteria and then tested by C.DIFF QUIK CHEK COMPLETE TEST.
In the Pediatric ICU (PICU) a total of 128 children were admitted and a total of 1044 patient days of surveillance were monitored. During the study period only 3 cases of HAD were diagnosed. The percent of hospitalized children who developed HAD was 2.3% equivalent to 23 HAD per 1000 admissions and the overall incidence of HAD was 2.9 per 1000 patient days of surveillance data. Despite the recent data denoting that a shift has occurred over the past decade, and C. difficile is increasingly being recognized as an important pediatric enteric pathogen in both healthcare and community settings, particularly in children 1-5 years of age, including children without traditional risk factors for C. difficile infections, in the present study C. difficile was not implicated in any of the three cases of HAD. The sample size is definitely a compromising factor limiting the value of the conclusion.
In the 4 general ICUs included in the present study the total admissions during the study period were 1230 and the total patient days of surveillance data was 5569: 2659 for each of: MUH ICU1 & MUH ICU3, 1065 days for NUH ICU7 and 667 for NUH ICU1. The overall incidence of HAD was 2.4% (29/1230) and 5.2 per 1000 patient days. The highest incidence was in NUH ICU1 where 7 (14.3%) episodes of diarrhea were recorded with an incidence of 10.5 per 1000 patient days while the lowest incidence was encountered in MUH ICU1 and NUH ICU 7: 1.1% and 1.5% and 3 and 2.8 per 1000 patient days respectively. There was a direct relationship between the LOS and the incidence of diarrhea per 1000 patient days. The longest mean length of stay and the highest incidence of diarrhea were in NUH ICU1: 13.6 and 10.5 respectively.
Regarding the role of C. difficile in HAD in the present study, it was found to be implicated in one (4.5%) out of the 22 cases of diarrhea in which stool samples were available for testing thus implicated in 0.81 per 1000 patient admissions to the 4 MUH & NUH ICUs and 0.74 per 1000 patient admissions to the 5 AUH ICUs included in the present study.
Intestinal colonization by C. difficile among infants in Egypt was not previously investigated. In the present study stools from two hundred and ninety two infants below 2 years of age hospitalized in the NICU and Pediatric wards of El-Shatby University Hospitals, were examined to detect for C. difficile colonization. The overall colonization was of 17.8%. Colonization was significantly highest among neonates (37.7%). Subsequently C. difficile colonization DROPped to 14% and 12.4% among the age groups >1 month -1year and >1-2 years respectively. In the present study, no colonization was detected in neonates up to 6 days of age, subsequently colonization by C. difficile was detected and peaked to 72.2% in the age group of >21- 30 days of age, with a mean colonization of 37.7% among neonates included in the present study. Then colonization DROPped to 18.3% among the age group from 1-6 months, 10% among the age group from >6-12 months and to 11.5% among children between one and 2 years of age.