Survey on the diagnosis and treatment of Clostridium difficile infection.

BACKGROUND: The toxigenic strains of Clostridioides (Clostridium) difficile is the most common pathogen of nosocomial and antibiotic-related diarrhoea in healthcare facilities. Lately, there has been an increase in the incidence of C. difficile infection (CDI) cases in Slovakia. MATERIALS AND METHODS: Retrospective analysis of the CDI appearance was carried out in the Zilina region. Additionally, an electronic survey focused on the diagnosis and treatment management of C. difficile infection was conducted among leading clinicians of the wards where CDI was present. RESULTS: Eighty percent of clinicians reported that they were following the recommendations for diagnosis and treatment of C. difficile infection in their everyday practice. The majority of leading physicians were from internal medicine wards (50 %). Most respondents stated that the laboratory results correlated with the clinical symptoms of patients. The first-choice treatment of C. difficile infections was reported to be oral vancomycin (in 21.7 %) and oral metronidazole (in 47.8 %). The estimate of first-choice treatment success rate was 80 %, while the recurrence rate and severe course was observed in 20%. Vancomycin was the standard treatment for recurrent infection. It was administered orally either alone (31 %) or combined with metronidazole (38 %) or fidaxomicin (31 %). CONCLUSION: The results of the survey showed that recommendations for the diagnosis and treatment were implemented in the wards of hospitals and showed the awareness of the necessity of rapid diagnosis and early treatment of C. difficile infection in patients (Fig. 4, Ref. 30).

Ribotypes in isolates and testing algorithm of C. difficile infections in the studied sample.

BACKGROUND: Clostridium (Clostridioides) difficile is the most common pathogen of nosocomial and antibiotic-related diarrhea in health-care facilities. The aim of the analysis was to show the testing algorithm and to identify hypervirulent strains (suspected RT 027). METHODS: The retrospective analysis of patient samples suspected on CDI was carried out by a two-step algorithm. Biological specimens were analysed by GDH or culture, immunoenzymatic assay on toxins A/B and selected samples also by a real-time PCR. RESULTS: In 1006 specimen suspected on CDI, 202 specimens were evaluated as positive in the two-step algorithm. Conflicting results (64 C. difficile isolates) were tested in a three-step algorithm by a real-time PCR and revealed 59 toxigenic and non RT 027 ribotypes. Statistically significant dependence among the independent variables, such as: diagnostic parameters and length of hospitalization (p = 0.175) and C. difficile (suspected RT027) ribotypes was not found. CONCLUSION: The results of PCR ribotyping showed a high prevalence of hypervirulent and toxigenic ribotypes in the studied sample. A resistance to vancomycin was found in one isolate. The PCR method contributed to the rapid laboratory diagnosis and thus treatment of high risk patients or was used as a third step in in the case of unclear results of standard diagnostic methods(Tab. 1, Fig. 4, Ref. 18). Text in PDF www.elis.sk.