Epidemiology of Clostridium difficile–Associated Diarrhea in a Peruvian Tertiary Care Hospital

Abstract

The prevalence, incidence, and epidemiologic factors of Clostridium difficile-associated diarrhea (CDAD) in a Peruvian hospital were studied. We conducted a cross-sectional study in patients > 14 years of age from medical/surgical wards of the Cayetano Heredia National Hospital (Lima, Peru) from September 2005 to May 2006. CDAD was defined in a case of nosocomial diarrhea when C. difficile toxin A and/or toxin B was detected by enzyme immune assay (EIA) in stools. A total of 4,264 patients were admitted, with 156 (3.7%) developing nosocomial diarrhea. Fifty-five of 156 (35.2%) cases of nosocomial diarrhea were diagnosed as CDAD. The overall incidence per 1,000 admissions was 12.9. Multivariate analysis showed that use of diapers (OR, 3.54; 95% CI, 1.71-7.34; P = 0.001) and presence of another patient with CDAD housed in the same room (OR, 2.97; 95% CI, 1.14-7.76; P = 0.026) were significantly associated with CDAD. Hospital transmission of C. difficile commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD in low-resource settings.

Clostridium difficile: a problem of concern in developed countries and still a mystery in Latin America

“…Based on multivariate analysis, the authors found that significant risk factors relating to the development of CDAD followed the same criteria as those already described the literature, namely the use of H2 blockers, age of over 65 years, prior hospitalization within 12 weeks of diagnosis, prior use of cephalosporins and fluoroquinolones, hospitalization at an ICU and extended hospital stays. García et al (2007a) studied the prevalence, incidence and epidemiology of CDAD in a tertiary-care hospital in Peru from September 2005to May 2006. Among the 4264 patients admitted to the hospital over the study period, 156 (3.7 %) developed nosocomial diarrhoea and 55 (35.5 %) of these cases were associated with C. difficile.…”

“…The authors highlighted that this characteristic has not been described before in an adult setting and suggested that the presence of multiple diapered patients in the same room is unfavourable when trying to prevent cross-infection. García et al (2007b) reported a unique case of a 30-yearold HIV-positive patient who died due to complications associated with PMC and co-infections of C. difficile, cytomegalovirus (CMV) and possibly Mycobacterium tuberculosis. The patient presented chronic diarrhoea over 1 year and was admitted to hospital with a cough, difficulty breathing and sensory disorder.…”

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

“…In an epidemiological study of C. difficile-associated diarrhoea in a Peruvian hospital, the reported overall incidence per 1000 admissions was 12.9. As the presence of another patient with CDI in the same room was significantly associated with the development of diarrhoea, the authors concluded that C. difficile transmission commonly occurred in this healthcare setting and highlighted the need for implementing adequate hygiene programmes [64] (Table 1). One of the most serious human health problems in developing regions is the microbial contamination of drinking water and foods, leading to severe gastrointestinal diseases that are exacerbated by under-nutrition and the lack of medical treatment in these regions.…”

Prevalence and risk factors of Clostridium difficile - associated diarrhea in Iranian hospitalized patients

“…[15] Prevalence of CDAD in adult inpatients from Saudi Arabia, Iran, India, chile, and Argantina have ranged from 4.6% to 22% respectively. [16][17][18][19][20] Three studies in Iranian hospitalized patients developing acute diarrhea showed prevalence rates of 5.3%, 6.7% and 21% respectively. [13,15,21] We found a prevalence rate of 7.4% in hospitalize patients.…”