Clostridium difficile infection in a university teaching hospital: focus on recurrences

Infectious Diseases and Tropical Medicine 2019; 5: e537
DOI: 10.32113/idtm_20199_537

  Topic: Hospital infection     Category:

Abstract

Objective: Although Clostridium Difficile Infection (CDI) is the leading cause of hospital infections, limited data on the burden of CDI in Italy are available. The management of relapses is the most important clinical problem to which, to date, there are no definitive solutions. The clinical findings are promising, although further studies are needed to better understand the role of these new therapeutic approaches in the management of CDI recurrence.
Materials and Methods: The study included all patients with CDI evaluated at the Infectious Disease Unit at the University Hospital of Sassari, from 1 January 2015 to 31 December 2017.
Microbiological diagnosis was performed by the search of glutammate dehydrogenase (GDH) and toxin A/B or by PCR. Demographic and clinical data were collected from the patient's medical records.
Results: A total of 35 CDI episodes were identified. All patients were Caucasian with a mean age of 72 years while 26 patients (72.2%) were female. Sixteen cases (45.7%) of CDI occurred in medical wards followed by Surgery Department. Out of the total, 11 were recurrences. In the study performed, out of 17 patients hospitalized in the Infectious Disease Unit, 9 were first infections and 8 were relapses. CDI occurred in the hospital setting in 9 cases; it occurred in the community in 4 cases; it was indeterminate in other 4 cases. The median hospital lenght of stay was 13.6 days, and there were two deaths. The most frequent clinical manifestations were: diarrhea with mucus and blood, watery diarrhea, fever, abdominal pain, renal failure, white blood cell count >16000 or <4000 cells/mm3. First infections were treated with vancomycin. Recurrents were treated with fidaxomicin in 4 cases and vancomycin in other 2 cases. Two patients with multiple recurrences were treated with vancomycin and fecal transplantation. The analysis of risk factors for recurrences showed that all patients had experienced antibiotic exposure, 7 were > 65 years old, 5 were taking PPIs, 4 had CD subtype 027, 3 had undergone surgical procedures and 3 had suffered from chronic renal failure.
Conclusions: Our data confirm the changing epidemiology of Clostridium and the high recurrence rate of CDI. Community infections accounted for 23.5% of CDI in accordance with the most recent European data. Recurrences represented nearly 47% of cases, exceeding the rate reported in literature. The high percentage of recurrences observed could be ascribed to the characteristics of the patient’s risk factors associated with the development of relapse.

To cite this article

Clostridium difficile infection in a university teaching hospital: focus on recurrences

Infectious Diseases and Tropical Medicine 2019; 5: e537
DOI: 10.32113/idtm_20199_537

Publication History

Submission date: 01 May 2019

Revised on: 28 Jun 2019

Accepted on: 03 Jul 2019

Published online: 06 Sep 2019