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Investigation of Clostridioides (Clostridium) difficile in patients with hospital-acquired diarrhea

Year 2023, Volume: 16 Issue: 3, 461 - 472, 18.12.2023

Eyyüp Kaya Candan Öztürk Seda Tezcan Ülger Hamide Kaya Sebahat Aslan Tek

Abstract

Aim: Clostridioides difficile infection is a healthcare-associated infection and is an important source of mortality and morbidity, especially for hospitalized patients. In our study, we aimed to determine the incidence of C. difficile in hospital-acquired diarrhea by isolating C. difficile and investigating the presence of toxin in stool samples of hospitalized patients. Method: The study included 85 patients over two years of age who had loose or watery stools more than three times a day for at least two days and hospitalized in various wards at Mersin University Hospital between October 2020 and July 2021. Stool samples collected in sealed containers were analyzed for the presence of C. difficile toxin A/B using the 'Epilisa Fecal C. difficile Toxin A/B ELISA Kit' (Epitope Diagnostics, Inc. ABD) within 24-48 hours. In addition, stool samples were cultured on C. difficile agar containing cycloserine, cefoxitin, amphotericin-B (Biomerieux, Fransa), ChromID C. difficile agar (Biomerieux, Fransa) and 5% sheep blood Columbia agar (Biomerieux, Fransa) media. The media were incubated in an anaerobic environment at 37°C for 48-72 hours and then evaluated. The colonies identified as C. difficile were inoculated on Schaedler Anaerobic Broth (Oxoid, İngiltere) and after 48-72 hours of anaerobic incubation, the presence of toxin was investigated by ELISA method. Results: ELISA toxin A/B positivity was found to be 4.7% (4/85) in our study. Six (7.1%) C. difficile isolates were isolated in anaerobic culture and the presence of toxin was detected in three of them (p=1.000). The frequency of CDE in our patient population was determined to be 3.5% (n=3). When toxigenic culture was taken as the reference test, the sensitivity, specificity, positive predictive value and negative predictive value of ELISA Toxin A/B test were determined as 100%, 98.8%, 75% and 100%, respectively. Conclusion: Rational antibiotic use and appropriate infection control programs should be considered in the prevention of CDE, which is associated with antibiotic use and hospitalization

Keywords

Hospital-acquired diarrhea Clostridium difficile toxin A/B anaerobic culture

Project Number

2021-1-TP3-4337

References

  • Wu KS, Syue LS, Cheng A, et al. Recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan. J Microbiol Immunol Infect. 2020;53(2):191-208. https://doi.org/10.1016/j.jmii.2020.02.002
  • Bamba S, Nishida A, Imaeda H, et al. Successful treatment by fecal microbiota transplantation for Japanese patients with refractory Clostridium difficile infection: a prospective case series. J Microbiol Immunol Infect. 2019;52(4):663-666. https://doi.org/10.1016/j.jmii.2017.08.027
  • Butt T, Raza S, Malik SN, Naqvi M. Risk factors for Clostridium difficile infection in patients on antibiotics. Pak J Phytopathol. 2017;28(1):1-5.
  • Zarandi ER, Mansouri S, Nakhaee N, Sarafzadeh F, Iranmanesh Z, Moradi M. Frequency of antibiotic associated diarrhea caused by Clostridium difficile among hospitalized patients in intensive care unit, Kerman, Iran. Gastroenterol Hepatol Bed Bench. 2017;10(3):229-234.
  • Spigaglia P. Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection. Ther Adv Infect Dis. 2016;3(1):23-42. https://doi.org/10.1177/2049936115622891
  • Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2011;31(5):431-455. https://doi.org/10.1086/651706
  • Labbe AC, Poırıer L, Maccannell D, et al. Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain. Antimicrob Agents and Chemother. 2008;52(9):3180–3187. https://doi.org/10.1128%2FAAC.00146-08
  • Edwards AN, Karim ST, Pascual RA, Jowhar LM, Anderson SE, McBride SM. Chemical and stress resistances of Clostridium difficile spores and vegetative cells. Front Microbiol. 2016;7:1698. https://doi.org/10.3389/fmicb.2016.01698
  • McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. https://doi.org/10.1093/cid/cix1085
  • Barbut F, Mastrantonio P, Delmée M, Brazier J, Kuijper E, Poxton I. Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin Microbiol Infect. 2007;13(11):1048-1057. https://doi.org/10.1111/j.1469-0691.2007.01824.x
  • Warny M, Pepın J, Fang A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet Infect Dis. 2005;366(9491):1079-1084. https://doi.org/10.1016/s0140-6736(05)67420-x
  • CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019. https://ndc.services.cdc.gov/wp-content/uploads/Antibiotic-Resistance-Threats-in-the-United-States-2019.pdf
  • Çitil BE. Clostridium difficile’ye bağlı ishal yönünden risk grubundaki olguların dışkıda toksin saptama yöntemleri ve anaerop kültür ile değerlendirilmesi. Uzmanlık Tezi, Sağlık Bakanlığı Refik Saydam Hıfsısıhha Merkezi, Ankara, Türkiye, 2006.
  • Şamlıoğlu P, Bayram A, Doğan G. Dışkı örneklerinden polimeraz zincir reaksiyonu ile saptanan Clostridium difficile Toksin B sonuçlarının değerlendirilmesi. Turk Hij Den Biyol Derg. 2022;79(2):209–216. https://dx.doi.org/10.5505/TurkHijyen.2022.77785
  • Lall S, Nataraj G, Mehta P. Use of culture and ELISA based toxin assay for detecting Clostridium difficile a neglected pathogen: A single-center study from a tertiary care setting. J Lab Physicians. 2017;9(4):254–259. https://doi.org/10.4103%2FJLP.JLP_157_16
  • Adler A, Bradenstein R, Block C, et al. A national survey of the molecular epidemiology of Clostridium difficile in Israel: the dissemination of the ribotype 027 strain with reduced susceptibility to vancomycin and metronidazole. Diagn Microbiol Infect Dis. 2015; 83(1):21-24. https://doi.org/10.1016/j.diagmicrobio.2015.05.015
  • Büyükbaba Boral Ö. Clostridium difficile infeksiyonu ön tanılı hastaların dışkı örneklerinde toksin A ve B’nin belirlenme sıklığı. Turk Mikrobiyol Cemiy Derg. 2003; 32:220-224.
  • Bhattacharya MK, Niyogi SK, Rasaily R, et al. Clinical manifestation of Clostridium difficile enteritis in Calcutta. J Assoc Physicians India. 1991;39(9):683–684.
  • Özyurt Ö. Akdeniz üniversitesi tıp fakültesi hastanesinde yatan iki yaş ve üzeri hastalarda Clostridium difficile ilişkili ishallerin toksijenik kültür, gdh enzim, toksin a/b ve PZR ile toksin genlerinin araştırılması. Uzmanlık Tezi, Akdeniz Üniversitesi, Tıp Fakültesi, Antalya, Türkiye, 2016.
  • Kostul H, Delialioğlu N, Horasan EŞ, Emekdaş G, Öztürk C, Kuyucu N. Antibiyotik kullanan hastalarda bağırsak florasının incelenmesi ve Clostridium difficile toksin araştırılması. Turk Hij Den Biyol Derg. 2015;72(3):183-190. DOI ID : 10.5505/TurkHijyen.2015.36024
  • Deniz U, Ulger N, Aks B, Karavus M, Soyletir G. Investigation of toxin genes of Clostridium difficile strains isolated from hospitalized patients with diarrhoea at Marmara University Hospital. Mikrobiyol Bul. 2011;45(1):1-10.
  • Sandora TJ, Fung M, Flaherty K, et al. Epidemiology and risk factors for Clostridium difficile infection in children. Pediatr Infect Dis J. 2011;30(7):580-584. https://doi.org/10.1097/inf.0b013e31820bfb29
  • Tai E, Richardon LC, Townsend J, Howard E, Mcdonald LC. Clostridium difficile infection among children with cancer. Pediatr Infect Dis J. 2011;30(7):610-612. https://doi.org/10.1097/inf.0b013e31820970d1
  • Altindis M, Usluer S, Ciftci H, Tunc N, Cetinkaya Z, Aktepe OC. Investigation of the presence of Clostridium difficile in antibiotic associated diarrhea patients by culture and toxin detection methods. Mikrobiyol Bul. 2007:41(1):29-37.
  • Andrés-Lasheras S, Martín-Burriel I, Aspiroz C, et al. Incidence and characterization of Clostridium difficile in a secondary care hospital in Spain. Rev Esp Enferm Dig. 2019;111(5):338-344. https://doi.org/10.17235/reed.2018.5288/2017
  • Şahin M. Hematoloji-Onkoloji servisinde yatan ve ayaktan takip edilen hastalarda Clostridium difficile görülme sıkılığı. Uzmanlık Tezi, İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, İstanbul, Türkiye, 2017.
  • Hung YP, Tsai CS, Tsai BY, et al. Clostridioides difficile infection in patients with hematological malignancy: A multicenter study in Taiwan. J Microbiol Immunol Infect. 2021;54(6):1101-1110. https://doi.org/10.1016/j.jmii.2021.02.002
  • Er A. Hacettepe Üniversitesi Tıp Fakültesi Erişkin ve Onkoloji Hastaneleri’nde Yatırılarak Tedavi Edilen Hastalarda Gelişen Clostridium difficile İnfeksiyonu Sıklığının Ve Risk Faktörlerinin Belirlenmesi. Uzmanlık Tezi, Hacettep Üniversitesi.Tıp Fakültesi, Ankara, Türkiye, 2016.
  • Öksüz Ş, Danış A, Öztürk E, Çalışkan E, Akar NK, Sungur MA. Uzun Süre Hastanede Yatan Hastalarda Clostridium difficile Kolonizasyonunun Araştırılması. Anadolu Klin. 2017;22(3):177-182. DOI: 10.21673/anadoluklin.298926
  • Xiao Y, Liu Y, Qin X. Comparative Study of Clostridium difficile Clinical Detection Methods in Patients with Diarrhoea. Can J Infect DisMed Microbiol. 2020:8753284. https://doi.org/10.1155%2F2020%2F8753284
  • Murray R, Boyd D, Levett P, Mulvey M, Alfa M. Truncation in the tcdC region of the Clostridium difficile PathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A. BMC Infect Dis. 2009;9:103. https://doi.org/10.1186%2F1471-2334-9-103
  • Vishwanath S, Singhal A, D'Souza A, Mukhopadhyay C, Varma M, Bairy I. Clostridium difficile infection at a tertiary care hospital in South India. J Assoc Physicians India. 2013;61(11):804-806.
  • Lee CC, Lee JC, Chiu CW, Tsai PJ, Ko WC, Hung YP. Clinical significance of toxigenic Clostridioides difficile growth in stool cultures during the era of nonculture methods for the diagnosis of C. difficile infection. Microbiol Spectr. 2021;31;9(2):e0079921. https://doi.org/10.1128/spectrum.00799-21
  • Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014;69(4):881–891. https://doi.org/10.1093/jac/dkt477

Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması

Year 2023, Volume: 16 Issue: 3, 461 - 472, 18.12.2023

Eyyüp Kaya Candan Öztürk Seda Tezcan Ülger Hamide Kaya Sebahat Aslan Tek

Abstract

Amaç: Clostridioides difficile enfeksiyonu, sağlık hizmeti ile ilişkili bir enfeksiyon olup özellikle hastanede yatan hastalar için önemli mortalite ve morbidite kaynağıdır. Çalışmamızda; hastane kaynaklı ishallerde C. difficile insidansını belirlemek için yatan hastaların gaita örneklerinde C. difficile izolasyonu ve toksin varlığının araştırılması amaçlanmıştır. Yöntem: Çalışmaya, Ekim 2020-Temmuz 2021 tarihleri arasında Mersin Üniversitesi Hastanesi’nde çeşitli servislere yatırılan, en az iki gün boyunca günde üçten fazla gevşek veya sulu dışkılama yapan, iki yaş üzerinde 85 hasta dahil edilmiştir. Sızdırmaz kaplarda toplanan gaita örneklerinde, 24-48 saat içinde ‘Epilisa Fecal C. difficile Toksin A/B ELISA kiti (Epitope Diagnostics, Inc. ABD) kullanılarak C. difficile toksin A/B varlığı araştırılmıştır. İlave olarak gaita örnekleri; sikloserin, sefoksitin, amfoterisin-B içeren C. difficile agar (Biomerieux, Fransa), ChromID C. difficile agar (Biomerieux, Fransa) ve %5 koyun kanlı Columbia agar (Biomerieux, Fransa) besiyerlerine ekilmiştir. Besiyerleri 37°C’lik etüvde anaerop ortamda 48-72 saat inkübe edildikten sonra değerlendirilmiştir. C. difficile olarak tanımlanan kolonilerden Schaedler Anaerop buyyona (Oxoid, İngiltere) ekim yapılmış ve 48-72 saatlik anaerop inkübasyonun sonunda ELISA yöntemiyle toksin varlığı araştırılmıştır. Bulgular: Çalışmamızda ELISA toksin A/B pozitifliği %4.7 (4/85) olarak bulunmuştur. Anaerop kültürde üreyen altı (%7.1) C. difficile izolatının üçünde toksin varlığı saptanmıştır (p=1.000). Hasta popülasyonumuzda CDE sıklığının %3.5 (n=3) olduğu belirlenmiştir. Toksijenik kültür referans test olarak alındığında, ELISA Toksin A/B testinin duyarlılık, özgüllük, pozitif prediktif değer ve negatif prediktif değeri sırasıyla; %100, %98.8, %75 ve %100 olarak belirlenmiştir. Sonuç: Antibiyotik kullanımı ve hastane yatışı ile ilişkili olan CDE’nun önlenmesinde akılcı antibiyotik kullanımı ve uygun enfeksiyon kontrol programlarının göz önünde bulundurulması gereklidir.

Keywords

Hastane kaynaklı ishal Clostridium difficile toksin A/B anaerobik kültür

Supporting Institution

Mersin Üniversitesi Bilimsel Araştırma Projeleri Birimi

Project Number

2021-1-TP3-4337

Thanks

İstatistiksel analiz bölümünde ve verilerin değerlendirilmesinde Mersin Üniversitesi Tıp Fakültesi Biyoistatistik ve Tıbbi Bilişim Anabilim Dalı’na teşekkür ediyoruz.

References

  • Wu KS, Syue LS, Cheng A, et al. Recommendations and guidelines for the treatment of Clostridioides difficile infection in Taiwan. J Microbiol Immunol Infect. 2020;53(2):191-208. https://doi.org/10.1016/j.jmii.2020.02.002
  • Bamba S, Nishida A, Imaeda H, et al. Successful treatment by fecal microbiota transplantation for Japanese patients with refractory Clostridium difficile infection: a prospective case series. J Microbiol Immunol Infect. 2019;52(4):663-666. https://doi.org/10.1016/j.jmii.2017.08.027
  • Butt T, Raza S, Malik SN, Naqvi M. Risk factors for Clostridium difficile infection in patients on antibiotics. Pak J Phytopathol. 2017;28(1):1-5.
  • Zarandi ER, Mansouri S, Nakhaee N, Sarafzadeh F, Iranmanesh Z, Moradi M. Frequency of antibiotic associated diarrhea caused by Clostridium difficile among hospitalized patients in intensive care unit, Kerman, Iran. Gastroenterol Hepatol Bed Bench. 2017;10(3):229-234.
  • Spigaglia P. Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection. Ther Adv Infect Dis. 2016;3(1):23-42. https://doi.org/10.1177/2049936115622891
  • Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2011;31(5):431-455. https://doi.org/10.1086/651706
  • Labbe AC, Poırıer L, Maccannell D, et al. Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain. Antimicrob Agents and Chemother. 2008;52(9):3180–3187. https://doi.org/10.1128%2FAAC.00146-08
  • Edwards AN, Karim ST, Pascual RA, Jowhar LM, Anderson SE, McBride SM. Chemical and stress resistances of Clostridium difficile spores and vegetative cells. Front Microbiol. 2016;7:1698. https://doi.org/10.3389/fmicb.2016.01698
  • McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. https://doi.org/10.1093/cid/cix1085
  • Barbut F, Mastrantonio P, Delmée M, Brazier J, Kuijper E, Poxton I. Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin Microbiol Infect. 2007;13(11):1048-1057. https://doi.org/10.1111/j.1469-0691.2007.01824.x
  • Warny M, Pepın J, Fang A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet Infect Dis. 2005;366(9491):1079-1084. https://doi.org/10.1016/s0140-6736(05)67420-x
  • CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019. https://ndc.services.cdc.gov/wp-content/uploads/Antibiotic-Resistance-Threats-in-the-United-States-2019.pdf
  • Çitil BE. Clostridium difficile’ye bağlı ishal yönünden risk grubundaki olguların dışkıda toksin saptama yöntemleri ve anaerop kültür ile değerlendirilmesi. Uzmanlık Tezi, Sağlık Bakanlığı Refik Saydam Hıfsısıhha Merkezi, Ankara, Türkiye, 2006.
  • Şamlıoğlu P, Bayram A, Doğan G. Dışkı örneklerinden polimeraz zincir reaksiyonu ile saptanan Clostridium difficile Toksin B sonuçlarının değerlendirilmesi. Turk Hij Den Biyol Derg. 2022;79(2):209–216. https://dx.doi.org/10.5505/TurkHijyen.2022.77785
  • Lall S, Nataraj G, Mehta P. Use of culture and ELISA based toxin assay for detecting Clostridium difficile a neglected pathogen: A single-center study from a tertiary care setting. J Lab Physicians. 2017;9(4):254–259. https://doi.org/10.4103%2FJLP.JLP_157_16
  • Adler A, Bradenstein R, Block C, et al. A national survey of the molecular epidemiology of Clostridium difficile in Israel: the dissemination of the ribotype 027 strain with reduced susceptibility to vancomycin and metronidazole. Diagn Microbiol Infect Dis. 2015; 83(1):21-24. https://doi.org/10.1016/j.diagmicrobio.2015.05.015
  • Büyükbaba Boral Ö. Clostridium difficile infeksiyonu ön tanılı hastaların dışkı örneklerinde toksin A ve B’nin belirlenme sıklığı. Turk Mikrobiyol Cemiy Derg. 2003; 32:220-224.
  • Bhattacharya MK, Niyogi SK, Rasaily R, et al. Clinical manifestation of Clostridium difficile enteritis in Calcutta. J Assoc Physicians India. 1991;39(9):683–684.
  • Özyurt Ö. Akdeniz üniversitesi tıp fakültesi hastanesinde yatan iki yaş ve üzeri hastalarda Clostridium difficile ilişkili ishallerin toksijenik kültür, gdh enzim, toksin a/b ve PZR ile toksin genlerinin araştırılması. Uzmanlık Tezi, Akdeniz Üniversitesi, Tıp Fakültesi, Antalya, Türkiye, 2016.
  • Kostul H, Delialioğlu N, Horasan EŞ, Emekdaş G, Öztürk C, Kuyucu N. Antibiyotik kullanan hastalarda bağırsak florasının incelenmesi ve Clostridium difficile toksin araştırılması. Turk Hij Den Biyol Derg. 2015;72(3):183-190. DOI ID : 10.5505/TurkHijyen.2015.36024
  • Deniz U, Ulger N, Aks B, Karavus M, Soyletir G. Investigation of toxin genes of Clostridium difficile strains isolated from hospitalized patients with diarrhoea at Marmara University Hospital. Mikrobiyol Bul. 2011;45(1):1-10.
  • Sandora TJ, Fung M, Flaherty K, et al. Epidemiology and risk factors for Clostridium difficile infection in children. Pediatr Infect Dis J. 2011;30(7):580-584. https://doi.org/10.1097/inf.0b013e31820bfb29
  • Tai E, Richardon LC, Townsend J, Howard E, Mcdonald LC. Clostridium difficile infection among children with cancer. Pediatr Infect Dis J. 2011;30(7):610-612. https://doi.org/10.1097/inf.0b013e31820970d1
  • Altindis M, Usluer S, Ciftci H, Tunc N, Cetinkaya Z, Aktepe OC. Investigation of the presence of Clostridium difficile in antibiotic associated diarrhea patients by culture and toxin detection methods. Mikrobiyol Bul. 2007:41(1):29-37.
  • Andrés-Lasheras S, Martín-Burriel I, Aspiroz C, et al. Incidence and characterization of Clostridium difficile in a secondary care hospital in Spain. Rev Esp Enferm Dig. 2019;111(5):338-344. https://doi.org/10.17235/reed.2018.5288/2017
  • Şahin M. Hematoloji-Onkoloji servisinde yatan ve ayaktan takip edilen hastalarda Clostridium difficile görülme sıkılığı. Uzmanlık Tezi, İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, İstanbul, Türkiye, 2017.
  • Hung YP, Tsai CS, Tsai BY, et al. Clostridioides difficile infection in patients with hematological malignancy: A multicenter study in Taiwan. J Microbiol Immunol Infect. 2021;54(6):1101-1110. https://doi.org/10.1016/j.jmii.2021.02.002
  • Er A. Hacettepe Üniversitesi Tıp Fakültesi Erişkin ve Onkoloji Hastaneleri’nde Yatırılarak Tedavi Edilen Hastalarda Gelişen Clostridium difficile İnfeksiyonu Sıklığının Ve Risk Faktörlerinin Belirlenmesi. Uzmanlık Tezi, Hacettep Üniversitesi.Tıp Fakültesi, Ankara, Türkiye, 2016.
  • Öksüz Ş, Danış A, Öztürk E, Çalışkan E, Akar NK, Sungur MA. Uzun Süre Hastanede Yatan Hastalarda Clostridium difficile Kolonizasyonunun Araştırılması. Anadolu Klin. 2017;22(3):177-182. DOI: 10.21673/anadoluklin.298926
  • Xiao Y, Liu Y, Qin X. Comparative Study of Clostridium difficile Clinical Detection Methods in Patients with Diarrhoea. Can J Infect DisMed Microbiol. 2020:8753284. https://doi.org/10.1155%2F2020%2F8753284
  • Murray R, Boyd D, Levett P, Mulvey M, Alfa M. Truncation in the tcdC region of the Clostridium difficile PathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A. BMC Infect Dis. 2009;9:103. https://doi.org/10.1186%2F1471-2334-9-103
  • Vishwanath S, Singhal A, D'Souza A, Mukhopadhyay C, Varma M, Bairy I. Clostridium difficile infection at a tertiary care hospital in South India. J Assoc Physicians India. 2013;61(11):804-806.
  • Lee CC, Lee JC, Chiu CW, Tsai PJ, Ko WC, Hung YP. Clinical significance of toxigenic Clostridioides difficile growth in stool cultures during the era of nonculture methods for the diagnosis of C. difficile infection. Microbiol Spectr. 2021;31;9(2):e0079921. https://doi.org/10.1128/spectrum.00799-21
  • Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014;69(4):881–891. https://doi.org/10.1093/jac/dkt477
There are 34 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Articles
Authors

Eyyüp Kaya 0000-0001-9328-0088

Candan Öztürk 0009-0000-8672-5181

Seda Tezcan Ülger 0000-0002-0823-3680

Hamide Kaya 0000-0002-2956-8762

Sebahat Aslan Tek 0000-0001-9839-0665

Project Number 2021-1-TP3-4337
Early Pub Date December 5, 2023
Publication Date December 18, 2023
Submission Date March 17, 2023
Acceptance Date July 7, 2023
Published in Issue Year 2023 Volume: 16 Issue: 3

Cite

APA Kaya, E., Öztürk, C., Tezcan Ülger, S., Kaya, H., et al. (2023). Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi, 16(3), 461-472.
AMA Kaya E, Öztürk C, Tezcan Ülger S, Kaya H, Aslan Tek S. Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması. Mersin Univ Saglık Bilim derg. December 2023;16(3):461-472.
Chicago Kaya, Eyyüp, Candan Öztürk, Seda Tezcan Ülger, Hamide Kaya, and Sebahat Aslan Tek. “Hastane Kaynaklı Ishallerde Clostridioides (Clostridium) Difficile araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16, no. 3 (December 2023): 461-72.
EndNote Kaya E, Öztürk C, Tezcan Ülger S, Kaya H, Aslan Tek S (December 1, 2023) Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16 3 461–472.
IEEE E. Kaya, C. Öztürk, S. Tezcan Ülger, H. Kaya, and S. Aslan Tek, “Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması”, Mersin Univ Saglık Bilim derg, vol. 16, no. 3, pp. 461–472, 2023.
ISNAD Kaya, Eyyüp et al. “Hastane Kaynaklı Ishallerde Clostridioides (Clostridium) Difficile araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi 16/3 (December 2023), 461-472.
JAMA Kaya E, Öztürk C, Tezcan Ülger S, Kaya H, Aslan Tek S. Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması. Mersin Univ Saglık Bilim derg. 2023;16:461–472.
MLA Kaya, Eyyüp et al. “Hastane Kaynaklı Ishallerde Clostridioides (Clostridium) Difficile araştırılması”. Mersin Üniversitesi Sağlık Bilimleri Dergisi, vol. 16, no. 3, 2023, pp. 461-72.
Vancouver Kaya E, Öztürk C, Tezcan Ülger S, Kaya H, Aslan Tek S. Hastane kaynaklı ishallerde Clostridioides (Clostridium) difficile araştırılması. Mersin Univ Saglık Bilim derg. 2023;16(3):461-72.
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MEU Journal of Health Sciences Assoc was began to the publishing process in 2008 under the supervision of Assoc. Prof. Gönül Aslan, Editor-in-Chief, and affiliated to Mersin University Institute of Health Sciences. In March 2015, Prof. Dr. Caferi Tayyar Şaşmaz undertook the Editor-in Chief position and since then he has been in charge.

Publishing in three issues per year (April - August - December), it is a multisectoral refereed scientific journal. In addition to research articles, scientific articles such as reviews, case reports and letters to the editor are published in the journal. Our journal, which has been published via e-mail since its inception, has been published both online and in print. Following the Participation Agreement signed with TÜBİTAK-ULAKBİM Dergi Park in April 2015, it has started to accept and evaluate online publications.

Mersin University Journal of Health Sciences have been indexed by Turkey Citation Index since November 16, 2011.

Mersin University Journal of Health Sciences have been indexed by ULAKBIM Medical Database from the first issue of 2016.

Mersin University Journal of Health Sciences have been indexed by DOAJ since October 02, 2019.

Article Publishing Charge Policy: Our journal has adopted an open access policy and there is no fee for article application, evaluation, and publication in our journal. All the articles published in our journal can be accessed from the Archive free of charge.

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