Epidemiology of Clostridium difficile-associated disease in internal medicine wards in northern Italy

Abstract

Clostridium difficile-associated disease (CDAD) is a growing health care problem. Elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. Few data are available on epidemiology of CDAD in Italy and no studies have focused on CDAD burden in internal medicine wards. We retrospectively analysed all CDAD cases in four internal medicine wards of a city hospital in northern Italy and reviewed the medical records of patients who developed CDAD during hospitalization. We identified 146 newly acquired cases, yielding a cumulative incidence of 2.56 per 100 hospitalizations and an incidence rate of 23.3 per 10,000 patient-days. Main risk factors were advanced age and length of hospitalization. A high proportion of CDAD patients had several comorbidities and had been treated with more than one antibiotic. The incidence is among the highest previously reported, this may be due to the characteristics of patients admitted to internal medicine wards and to the wards per se. We conclude that efforts are needed to reduce CDAD's burden in this setting, paying attention to logistics, patients care and antibiotic use.

Clostridium Difficile Colitis in the United States: A Decade of Trends, Outcomes, Risk Factors for Colectomy, and Mortality after Colectomy

“…Consistent with studies from the 1990s and the first half of the 2000s, which reported a rising incidence of CDC in the United States, 4,29-31 the results of our study demonstrate that the incidence of CDC continues to increase among hospitalized patients. This appears to be a worldwide health concern, as reports from Japan, 32 Europe, [33][34][35][36] and Canada 37 are also documenting rising trends of CDC cases. The more concerning facts are the rising numbers of colectomies performed for CDC, which appear again as a continuation of a previously observed trend that started in the mid 1990s.…”

Fecal microbiota transplantation for fulminant Clostridium difficile infection in an allogeneic stem cell transplant patient

“…Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients, with a reported incidence of 23.3–29.2 cases per 10,000 inpatient days . The spectrum of illness caused by C. difficile infection (CDI) ranges from mild diarrhea to fulminant colitis, intestinal perforation, and death in up to 8% of infected individuals .…”

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

“…Further, it was possible to systematically apply (in all cases with diarrhoea) the same approach for laboratory diagnosis of CDI, along with a post-hoc assessment for all GDH positive samples; together with the rigorous method for selection of participating centers and the screening of the total population of all patients admitted to IMUs, this reasonably makes our findings of interest and accurate for the specific study setting. On the other hand, as a possible limitation of our study, the 4-month enrolment period may have obscured possible seasonal variations in the occurrence of CDI, as previously reported [18]. In addition, no follow-up was scheduled for patients with GDH+/Tox- samples, and since some of these patients were considered positive for CDI by the PCR method, this could make our outcome results not complete.…”