Possible Diagnosis for Clostridium Difficile and Its Toxins in Písek Hospital, a.s.

At present, nosocomial infections, i.e. infections connected with the health care, are a serious issue in all hospitals. These infections also include intestinal infections caused by Clostridium difficile. Clostridium difficile is a movable, anaerobic gram-positive rod, which is able to form spores. It may be found in the intestines of about 5 % of healthy adults. Toxigenic strains of Clostridium difficile generate two thermolabile protein toxins, enterotoxin (toxin A) and cytotoxin (toxin B). With these toxins, it may cause intestinal infectious disease of various severity, which may occur as trivial diarrhoea or as a life-threatening condition. In literature, the disease is referred to as Clostridium difficile infection (CDI) (Beneš et al., 2014a). The disease belongs to infections connected with health care and it often occurs as a result of previous treatment with antibiotics. In recent years, the number of CDI cases reported in the Czech Republic has apparently increased. 303 cases were reported in 2008 compared to 4 097 cases in 2014 (Pokorná, 2015). The aim of the thesis is to consider whether the method(s) applied for CDI diagnostics in laboratory in Nemocnice Písek, a.s. are sufficient or whether another method should be implemented. Laboratory procedure was compared with recommended procedures. Using qualitative, immunochromatographic method, the presence of clostridium glutamate dehydrogenase as well as the presence of toxins A and B were demonstrated. The results were utilized for statistical purposes and determination of hypotheses. Obtained data were calculated by means of Chi quadrate test in order to define the achieved level of severity. My assumption is that the recovery of Clostridium difficile and its toxins increased in Nemocnice Písek, a.s. in 2014 compared to 2013. I presume that patients over 65 years of age are more sensitive to CDI than patients up to 65 years of age (Beneš et al., 2014b, p. 58). Representation of genders in my setting in 2013 and in 2014 was also focused on as well as positive results of men and women. Method applied to diagnose CDI in Písek hospital is sufficient. In total, 240 samples were examined in 2013, out of which 209 were negative, i.e. 87.1 %, and 31 samples were positive (12.9 %). Total number of men was 132 (55.0 %), number of women was 108 (45 %). In 2014, 195 samples were examined in total, out of which 169 samples were negative, i.e. 86.7 %, 26 samples were positive, i.e. 13.3 %. In 2014, 195 samples were examined in total, out of which 122 samples were taken from patients over 65 years old (62.6 %) and 73 samples from patients under 65 years old (37.4 %). In 2013, 132 samples were taken from men and examined, out of which 19 were positive, i.e. 14.4 %. 108 samples were taken from women, out of which 12 were positive, i.e. 11.1 %. In 2014, 75 samples taken from men were examined (38.5 %), out of which 12 samples were positive, i.e. 16 %. In total, 120 samples were taken from women (61.5 %), out of which 14 samples were positive, which represents 11.7 %. Recovery of Clostridium difficile fecal samples in 2014 is similar to 2013. In my setting, patients over 65 were not more sensitive to the infection compared to younger patients. These results differ from literature stating that the incidence and severity of the disease is increasing significantly after 65 years of age. With regard to the results, I also assume that gender influences the sensitivity to CDI only slightly. For further study, larger sample of patients or longer time span for monitoring would be needed