Background: Clostridium difficile is currently recognized as an important nosocomial enteric pathogen. The significance as etiologic agent of community and nosocomial diarrhea is not well known in Spain.
Methods: Retrospective study of all cases of community diarrhea that required admission in the hospital and all nosocomial diarrhea observed in a period of three months in a 450-bed university hospital. We performed conventional coprocultives and detection of toxin-A of C. difficile with the method ELISA Premier.
Results: During the period of study were included 66 patients, 19 pediatrics and 47 adults patients (23 males, 24 females, age: 54.5 +/- 21.8 years). Three cases (15.8%) of pediatrics patients were diagnosticated of antibiotic-associated diarrhea, only one case were of nosocomial origin. Toxin A of C. difficile were detected in 6 cases, all were patients under two years old, represented 60% of these patients. The origin of diarrhea were: community in 32 cases and nosocomial in 15 of adults patients, in 18 cases (38.3%) were diagnosticated antibiotic-associated diarrhea, 11 were nosocomial. Toxin A of C. difficile were detected in 12 patients, 25.5% of adults, and 4 cases had criteria of C. difficile associated diarrhea, representing 8.5% of the diarrhea. None of this cases were suspected during admission.
Conclusions: Antibiotic-associated diarrhea and C. difficile associated diarrhea were not infrequent cause of diarrhea of nosocomial and of community origin in our environment. We recommended culture and/or detection of toxins of C. difficile in patients who were treated with antibiotics and diarrhea of more than 72 hours of evolution.