Clostridioides (Clostridium) difficile is the main etiology underlying antibiotic-associated diarrhea (AAD). Still, few Brazilian data are available on this infection. The aims of this multicenter study were to identify the prevalence, clinical characteristics, and outcomes of C. difficile infection (CDI) in patients with antibiotic associated diarrhea at eight hospitals in Curitiba, southern Brazil, during the years 2017–2019. Stool samples were tested using enzyme immunoassay for glutamate dehydrogenase antigen (GDH) and A/B toxins. Positive GDH samples were further evaluated by real-time polymerase chain reaction (PCR) for the presence of genes encoding toxin B (tcdB), binary toxin (cdt), and marker of hypervirulent C. difficile strain (tcdC deletion). The prevalence of CDI in 351 patients with AAD included in the study was 17.7% (n = 62). Among the CDI cases, tcdB was positive in all 62 stool samples, while cdt was positive in 10 samples, and tcdC deletion was positive in only two. Carriage of carbapenem-resistant Gram-negative bacilli, previous hospitalization, and use of broad-spectrum cephalosporin and carbapenem were associated with CDI. Among patients with CDI, 64.5% presented with severe diarrhea, and 8% (5/62) progressed with colitis and required intensive care. The 30-day mortality was 24% (15/62), and the CDI-associated mortality was 4.8% (3/62). Overall, 83.8% (52/62) of the patients achieved primary cure, and 20.8% of the evaluated patients (10/48) presented CDI recurrence. The treatment administered was not significantly associated with the 60-day recurrence or mortality. In conclusion, we reported in this study data of prevalence and recurrence rates of CDI in patients with AAD and evaluated the number of severe cases and infection-related mortality, which were up to now unknown in Southern Brazilian hospitals.

艰难梭菌（Clostridium）的病因是抗生素相关性腹泻（AAD）的主要病因。不过，巴西尚缺乏有关这种感染的数据。这项多中心研究的目的是确定在巴西南部库里蒂巴的八家医院在2017-2019年期间抗生素相关性腹泻患者的艰难梭菌感染（CDI）的患病率，临床特征和结局。使用酶免疫法检测粪便样品中的谷氨酸脱氢酶抗原（GDH）和A / B毒素。通过实时聚合酶链反应（PCR）进一步评估阳性GDH样品中是否存在编码毒素B（tcdB），二元毒素（cdt）和高毒力梭状芽胞杆菌标记的基因株（tcdC缺失）。纳入研究的351名AAD患者的CDI患病率为17.7％（n = 62）。在CDI病例中，所有62个粪便样本中tcdB呈阳性，而10个样本中cdt呈阳性，而tcdC仅有两个删除是阳性的。耐碳青霉烯类革兰氏阴性杆菌的运输，先前的住院治疗以及广谱头孢菌素和碳青霉烯类的使用均与CDI相关。在CDI患者中，有64.5％表现为严重腹泻，而8％（5/62）表现为结肠炎并需要重症监护。30天死亡率为24％（15/62），与CDI相关的死亡率为4.8％（3/62）。总体而言，有83.8％（52/62）的患者实现了原发性治愈，有20.8％的评估患者（10/48）出现了CDI复发。所给予的治疗与60天的复发或死亡率无明显关联。总之，我们在这项研究中报告了AAD患者CDI的患病率和复发率，并评估了重症病例数和感染相关死亡率，