Highlights
- •Clostridium difficile infection incidence achieved a dramatic increase in 2009/2010 in Coimbra, Portugal.
- •Peak incidence coincided with the introduction of alcohol-based hand products.
- •Increase in carbapenem and quinolone prescription had also a potential influence.
- •A possible outbreak of an epidemic strain cannot be excluded.
Abstract
Background
Clostridium difficile is the main cause of healthcare-associated diarrhoea. Its incidence,
severity and relapse rates increased over the past two decades.
Aim
To study epidemiologic characteristics and treatment of Clostridium difficile infection
(CDI) and compare with a previous cohort from the same hospital.
Method
Retrospective analysis of clinical records of CDI diagnosed from 2010 to 2015 and comparison with data from 2004 to 2009.
Results
259 cases were diagnosed, compared to 83 in 2004–2009. There was no difference in
mean annual incidence (8.66 versus 7.11 per 1000 patients; p = .116), but a dramatic increase was observed in 2009/2010 (peak incidence: 21.63
cases per 1000 admissions). Females were more affected (61.4% versus 69.9%; p = .177). Median age was 80 and 83 (p = .097). We observed an increase in median number of antibiotics previously used
(2 versus 3; p = .147) and in community-associated CDI (6% versus 19.7%; p = .003). There was a continued increase in the use of carbapenems and quinolones
until 2010 and a high percentage of refractory cases in 2010. Female gender (p = .043), long-term care facility (LTCF) residency (p = .022) and a higher number of previous antibiotics (median of 3; p = .025) were independent predictors for refractory and recurrent CDI.
Conclusions
CDI incidence achieved a peak in 2009/2010 coinciding with the introduction of alcohol-based
hand products, increase in quinolone and carbapenem prescription and a possible outbreak
of an epidemic strain. Female gender, LTCF residency and exposure to three or more
antibiotics are risk factors for refractory and recurrent CDI. We emphasize the need
to restrict use of large spectrum antibiotics.
Keywords
Abbreviations:
CDI (Clostridium difficile infection), CA-CDI (community-associated CDI), HA-CDI (healthcare-associated CDI), OR (odds ratio), LTCF (long-term care facilities)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 18, 2018
Accepted:
October 15,
2018
Received:
October 9,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
