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Observational Study
. 2016 Nov 8;16(1):656.
doi: 10.1186/s12879-016-1961-9.

Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

Giorgio Cioni  1 , Pierluigi Viale  2 , Stefania Frasson  3 , Francesco Cipollini  4 , Francesco Menichetti  5 , Nicola Petrosillo  6 , Sergio Brunati  7 , Patrizia Spigaglia  8 , Chiara Vismara  9 , Alessandra Bielli  9 , Fabrizio Barbanti  8 , Giancarlo Landini  10 , Grazia Panigada  11 , Gualberto Gussoni  12 , Erminio Bonizzoni  13 , Giovanni Pietro Gesu  9 ; Research Department of FADOI
Collaborators, Affiliations
Observational Study

Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study

Giorgio Cioni et al. BMC Infect Dis. .

Abstract

Background: Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy.

Methods: PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy.

Results: Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days.

Conclusions: Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.

Keywords: Clostridium difficile; Incidence; Internal Medicine; Outcome; Predictors.

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Figures

Fig. 1
Fig. 1
Flow-chart of the study
Fig. 2
Fig. 2
Multivariable analysis to evaluate factors potentially associated with CD infection. Odds Ratios were mutually adjusted for the other variables presented in the Figure. Bars represent the 95 % Confidence Intervals
Fig. 3
Fig. 3
Distribution of CD ribotypes identified in the study population
See this image and copyright information in PMC

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