Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2015; 21(21): 6728-6735
Published online Jun 7, 2015. doi: 10.3748/wjg.v21.i21.6728
Burden of Clostridium difficile infection between 2010 and 2013: Trends and outcomes from an academic center in Eastern Europe
Zsuzsanna Kurti, Barbara D Lovasz, Michael D Mandel, Zoltan Csima, Petra A Golovics, Bence D Csako, Anna Mohas, Lorant Gönczi, Krisztina B Gecse, Lajos S Kiss, Miklos Szathmari, Peter L Lakatos
Zsuzsanna Kurti, Barbara D Lovasz, Michael D Mandel, Zoltan Csima, Petra A Golovics, Bence D Csako, Anna Mohas, Lorant Gönczi, Krisztina B Gecse, Lajos S Kiss, Miklos Szathmari, Peter L Lakatos, 1st Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary
Zoltan Csima, Institute of Health Care Development and Clinical Methodology, Semmelweis University, H-1083 Budapest, Hungary
Author contributions: Kurti Z and Lovasz BD contributed equally to this work; Kurti Z and Lovasz BD contributed to supervision, patient selection and validation, database construction, and manuscript preparation; Mandel MD, Csima Z, Golovics PA, Csako BD, Mohas A, Gönczi L, Gecse KB, Kiss LS and Szathmari M contributed to database construction and manuscript preparation; Lakatos PL contributed to study design, data collection, supervision, patient selection and validation, database construction, statistical analysis, and manuscript preparation; all authors have approved the final draft submitted.
Ethics approval: The study protocol was reviewed and approved by the Semmelweis University Regional and Institutional Committee of Science and Research Ethics (TUKEB 56/2013).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter L Lakatos, MD, PhD, 1st Department of Medicine, Semmelweis University, Koranyi S. 2/A, H-1083 Budapest, Hungary. lakatos.peter_laszlo@med.semmelweis-univ.hu
Telephone: +36-1-2100278 Fax: +36-1-3130250
Received: October 15, 2014
Peer-review started: October 18, 2014
First decision: November 14, 2014
Revised: November 20, 2014
Accepted: January 30, 2015
Article in press: January 30, 2015
Published online: June 7, 2015
Processing time: 238 Days and 16.1 Hours
Abstract

AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI).

METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed.

RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1% of all-cause hospitalizations and 4.45% of total inpatient days). The incidence of severe CDI was 12.6% (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4% (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3% within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3% of all-inpatient deaths, and 30-d mortality rate was 21.9% (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P < 0.001], use of proton pump inhibitors (OR = 2.082, P < 0.001), previous hospitalization within 12 mo (OR = 3.167, P < 0.001), previous CDI (OR = 15.32; P < 0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P < 0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P < 0.001), and antibiotic therapy duration was longer (P < 0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ.

CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.

Keywords: Clostridium difficile infection; Hospitalization; Antibiotics; Proton pump inhibitors

Core tip:Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. It has a high economic burden and its incidence is rapidly increasing in long-term care facilities and acute care hospitals. In the present study, we reported an epidemic of CDI with one of the highest incidences to date. Previous antibiotic treatment, proton pump inhibitor use, previous hospitalization, higher Charlson Comorbidity Index, and previous CDI were identified as predictive factors. CDI was associated with a high healthcare burden, long hospital stay and high mortality.