ABSTRACT
OBJECTIVES: To describe clinical characteristics and outcome of Clostridium difficile infection (CDI) patients in Internal Medicine, to identify ribotypes (RTs); to evaluate the association between RT and patient clinical characteristics and report outcome. METHODS: One year prospective cohort study. Clinical data, Barthel Index (BI) and outcomes were collected for all inpatients suffering from CDI (nâ¯=â¯148) in hospital wards in Northern Italy. 84 fecal samples were analysed for molecular typing. RESULTS: 12 RTs were identified, predominantly RT018 (42.9%, nâ¯=â¯36/84) and RT356/607 (40.5%, nâ¯=â¯34/84). Patients with dementia were more frequent among those infected by RT018 [55.6% (nâ¯=â¯20/36) vs. 32.4% (nâ¯=â¯11/34), pâ¯=â¯0.05]. The median BI score of patients with RT018 was lower than BI score of patients with RT356/607 [10 (IQR 0-32) vs. 15 (IQR 5-50), pâ¯=â¯0.06]. RT018 infection was associated to higher levels of C-reactive protein [7.2â¯mg/dl (IQR 4.1-14.7) vs. 4.0â¯mg/dl (IQR 2.2-6.8), pâ¯=â¯0.01] and white blood cells ≥15,000/dl [33.3% (nâ¯=â¯12/36) vs. 14.7% (nâ¯=â¯5/34) of patients, pâ¯=â¯0.07]. Higher mortality was noted among RT018 infected patients. We found a continuous mortality increase according to the ATLAS score. CONCLUSIONS: Our results confirm that RT018 and RT356/607 are the two major RTs causing CDI in older patients with a high degree of disability in Northern Italy and RT018 is associated with more serious outcomes.
Subject(s)
Clostridioides difficile/classification , Clostridium Infections/mortality , Ribotyping , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Clostridioides difficile/isolation & purification , Clostridium Infections/drug therapy , Cross Infection , Feces/microbiology , Female , Humans , Italy , Kaplan-Meier Estimate , Male , Middle Aged , Multivariate Analysis , Polymerase Chain Reaction , Proportional Hazards Models , Prospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND: Clostridium difficile-associated disease (CDAD) is the most common infectious antibiotic-associated diarrhea and is a growing health care problem. Prevention of Clostridium difficile infection focuses on clinical and epidemiologic infection control measures. METHODS: Between 2008 and 2009, we conducted a retrospective study that showed an incidence of CDAD among the highest reported in the literature. Subsequently, we developed a preventive protocol that was adopted in our hospital in 2010. We then conducted a prospective study to investigate prevalence, incidence, and mortality of CDAD and to compare the results with those of the retrospective study, evaluating adherence to preventive measures and their efficacy. RESULTS: In both studies, prevalence and incidence significantly increased in older patients. Crude prevalence was similar in the 2 studies. The incidence rate increased by 36%, with a significant increase only in the C and D wards. In-hospital mortality rose in both prevalent and incident cases. Regarding adhesion to hospital protocol, 77% of prevalent cases were treated with the required procedure. The highest percentage of isolated patients was achieved in C and D wards. In these wards we detected lower training hours per nurse. However, in 2013, we observed a significant decrease in incidence of CDAD and found a hospital prevalence of 0.33%. CONCLUSIONS: Health care personnel education could be more important than the possibility of isolating infected patients in single rooms.