Epidemiology of Clostridium difficile Infection in Inpatients at University of Port Harcourt Teaching Hospital, Rivers State

Clostridium (Clostridioides) difficile infection (CDI) is the leading cause of nosocomial antibiotic-associated diarrhoea globally, yet its epidemiology in Nigerian tertiary hospitals is severely undercharacterized due to limited diagnostic capacity. This study investigated CDI prevalence, risk factors, and clinical outcomes in inpatients at the University of Port Harcourt Teaching Hospital, Rivers State, South South Nigeria. A prospective cohort of 200 inpatients who developed diarrhoea during hospitalization following antibiotic therapy was enrolled over eight months. Stool samples were tested for C. difficile by glutamate dehydrogenase (GDH) antigen detection (screening), C. difficile toxin A/B immunoassay (confirmation), and anaerobic culture on cycloserine-cefoxitin-fructose agar for CDI-positive cases. Isolates were characterized for binary toxin genes (cdtA/cdtB) and tested for susceptibility to metronidazole, vancomycin, and fidaxomicin. CDI was confirmed in 14.5 percent of enrolled patients. Significant risk factors included prior broad-spectrum antibiotic use of more than 5 days (OR: 4.2), proton pump inhibitor use (OR: 2.6), and ICU admission (OR: 3.1). The binary toxin gene was detected in 31 percent of toxigenic isolates. All isolates were susceptible to metronidazole and vancomycin. CDI-associated prolonged hospital stay averaged an additional 9.3 days. These findings confirm CDI as an underdiagnosed but clinically significant nosocomial pathogen in South South Nigeria and recommend routine CDI surveillance, antibiotic stewardship, and improved diagnostic algorithms in tertiary hospitals. Keywords: Clostridioides difficile, CDI, nosocomial diarrhoea, antibiotic-associated, Port Harcourt.