Clostridium difficile infection as a complication of anti-tuberculosis treatment

Abstract

Background. Clostridium difficile infection (CDI) is a potentially life-threatening complication associated with long-term antibiotic treatment. The frequency and developmental features of CDI occurring as a complication of antituberculosis treatment have been only sporadically reported in the literature. Objective(s). To assess the frequency and aspects of clinical characteristics of Clostridium difficile in TB patients, who were hospitalized in a specialized tertiary medical institution. Materials and methods. An observational, retrospective study was conducted including all tuberculosis (TB) patients hospitalized in the Institute of Pneumology “Chiril Draganiuc” of the Republic of Moldova between January 01, 2023 and December 31, 2023, who developed CDI. Clinical signs and diagnostic criteria of all CDI patients were analyzed. Results. The study included 25 patients (16 males, 9 females), who were diagnosed with CDI during anti-TB treatment, mean age being 52±12.4 years. Symptoms of CDI appeared after 15 [IDC 11-30] days, predominantly diarrhea (84%) and abdominal cramps (44%). Fever was present in 12% and leukocytosis in 68% of patients. In most of the cases the diagnosis of CDI was based on clinical criteria. Only 36% of patients had positive GDH test and 16% concomitant A/B toxin positive. Relapses occurred in 24% of patients. Discontinuation of antituberculosis treatment was required in 80% of the patients, median duration 8.5 [IDC 6-13] days. Conclusion(s). In the majority of TB patients, CDI was mild or moderate, without having major impact on treatment. Diagnosis of ICD was predominantly based on clinical criteria, immunologic tests were often uncertain, necessitating the implementation of nucleic acid amplification tests.