Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Abstract

Clostridium difficile infection (CDI) produces a variety of clinical presentations ranging from mild diarrhea to severe infection with fulminant colitis, septic shock, and death. CDI puts a heavy burden on healthcare systems due to increased morbidity and mortality, and higher costs. We evaluated the clinical impact of CDI in terms of complications and mortality in a French university hospital compared with patients with diarrhea unrelated to CDI. A 3-year prospective, observational, cohort study was conducted in a French university hospital. Inpatients aged 18 years or older with CDI-suspected diarrhea were eligible to participate in the study and were followed for up to 60 days after CDI testing. Among the 945 patients with diarrhea included, 233 had confirmed CDI. Overall, 106 patients (11.2%) developed at least one of the following complications: colectomy, colitis, ileitis/rectitis, ileus, intestinal perforation, megacolon, multiorgan failure, pancolitis, peritonitis, pseudomembranous colitis, renal failure, and sepsis/septic shock. The complication rate was significantly higher in patients with diarrhea related to C. difficile than in non-CDI patients (26.6% vs 6.2%, P < 0.001). At day 60, 137 (14.5%) patients had died, with 37 deaths among the CDI group (15.9%). Death was attributable to CDI in 15 patients (6.4%). Complications are more frequent among CDI cases than in patients with diarrhea not related to C. difficile. Assessment of CDI is necessary to ensure allocation of sufficient resources to CDI prevention.

Establishment of a French surveillance system of Clostridiodes difficile infection: Comparison of patient’s characteristics with other national and European data

“…A bias regarding a specific interest for hospital acquired cases might not be eliminated. The recurrence rate in this study fits well with French and European data despite the different clinical definitions used in those studies [15]. In addition, the crude mortality rates were similar between the epidemiological sources which underscore the lack of major differences regarding the clinical severity of the CDI cases by epidemiological design.…”

Effect of Restriction of Fluoroquinolone Antibiotics on Clostridioides difficile Infections in the University Hospital Hradec Králové

“…The data about total number of examined patients and patients diagnosed with the CDI, the CDI incidence, prevalence of tcdC gene deletion and fluoroquinolones consumption are shown in Table 1 and Figure 1. 2 number of confirm CDI, 3 CDI incidence in cases per 10,000 patientbed days, 4 prevalence of tcdC gene deletion in % (absolute) and 5…”

“…Clostridium difficile , recently reclassified as Clostridioides difficile [ 1 ] is the most common pathogen responsible for hospital-acquired diarrhea which is associated especially with previous antibiotic therapy. In particular, elder patients over 65 years with simultaneous presence of other comorbidities are endangered by more serious course of C. difficile infection (CDI) manifesting as pseudomembranous colitis, intestinal perforation, and septic shock leading to the patient death [ 2 ]. However, CDI represent not only a medical but also an epidemiological challenge.…”