Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011

BMC Infectious Diseases

Nicola Petrosillo⁵  Grazia Prignano⁶  Patrizia Chiaradonna¹  Maria C Cava³  Daniela Capozzi²  Eugenio Bordi⁵  Marcello Meledandri⁴  Maria A Cataldo⁵  Maria Musso⁵  Stefano Di Bella⁵ 

[1] San Camillo-Forlanini Hospital, Circ, Gianicolense 87, Rome, 00152, Italy;G.B. Grassi Hospital, Via Passeroni 28, Ostia Lido, Rome, 00122, Italy;Sandro Pertini Hospital, Via Monti Tiburtini 385, Rome, 00157, Italy;S. Filippo Neri Hospital, Via Martinotti 20, Rome, 00135, Italy;National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense 292, Rome, 00149, Italy;San Gallicano Dermatologic Institute, IRCCS IFO, Via Elio Chianesi 53, Rome, 00144, Italy

关键词: Europe;    Hospitals;    Italy;    Incidence;    Epidemiology;    Clostridium difficile;   

Others  :  1149249
DOI  :  10.1186/1471-2334-13-146

 received in 2012-05-11, accepted in 2013-03-15,  发布年份 2013

【 摘 要 】

Background

In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found.

We have conducted a 6-year retrospective study to evaluate the incidence of CDI in Italian urban hospitals.

Methods

Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded.

Results

A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%).

Conclusions

A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable.

【 授权许可】

   
2013 Di Bella et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Kelly CP, LaMont JT: Clostridium difficile—more difficult than ever. N Engl J Med 2008, 359:1932-1940.
• [2]Gravel D, Miller M, Simor A, Taylor G, Gardam M, McGeer A, Hutchinson J, Moore D, Kelly S, Boyd D, Mulvey M: Canadian Nosocomial Infection Surveillance Program: Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis 2009, 48:568-576.
• [3]Kyne L, Hamel MB, Polavaram R, Kelly CP: Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002, 34:346-353.
• [4]Zilberberg MD, Shorr AF, Kollef MH: Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis 2008, 14:929-931.
• [5]Nogareda F, Soler P, LLácer A: Increases in Clostridium difficile-related mortality rates in Spain (1999–2006). Enferm Infecc Microbiol Clin 2009, 27:484-485.
• [6]Office for National Statistics: Deaths involving Clostridium difficile: England and Wales, 1999 and 2001–06. Health Stat Q 2008, 37:52-56.
• [7]Gerding DN, Muto CA, Owens RC Jr: Treatment of Clostridium difficile infection. Clin Infect Dis 2008, 46(Suppl 1):S32-S42.
• [8]Lowy I, Molrine DC, Leav BA, Blair BM, Baxter R, Gerding DN, Nichol G, Thomas WD Jr, Leney M, Sloan S, Hay CA, Ambrosino DM: Treatment with monoclonal antibodies against Clostridium difficile toxins. N Engl J Med 2010, 362:197-205.
• [9]Dubberke ER, Butler AM, Yokoe DS, Mayer J, Hota B, Mangino JE, Khan YM, Popovich KJ, Fraser VJ: Multicenter study of Clostridium difficile infection rates from 2000 to 2006. Infect Control Hosp Epidemiol 2010, 31:1030-1037.
• [10]Asensio A, Vaque-Rafart J, Calbo-Torrecillas F, Gestal-Otero JJ, López-Fernández F, Trilla-Garcia A, Canton R, EPINE Working Group: Increasing rates in Clostridium difficile infection (CDI) among hospitalized patients, Spain 1999–2007. Euro Surveill 2008, 13:350-353.
• [11]Burckhardt F, Friedrich A, Beier D, Eckmanns T: Clostridium difficile surveillance trends, Saxony, Germany. Emerg Infect Dis 2008, 14:691-692.
• [12]Barbut F, Mastrantonio P, Delmée M, Brazier J, Kuijper E, Poxton I: European Study Group on Clostridium difficile (ESGCD): Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterization of the isolates. Clin Microbiol Infect 2007, 13:1048-1057.
• [13]Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, Monnet DL, van Dissel JT, Kuijper EJ, ECDIS Study Group: Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011, 377:63-73.
• [14]Sansone S, Aschbacher R, Staffler M, Bombonato M, Girardi F, Larcher C, Wiedermann CJ: Nosocomial diarrhea in adult medical patients: the role of Clostridium difficile in a North Italian acute care teaching hospital. J Prev Med Hyg 2009, 50:117-120.
• [15]Spigaglia P, Barbanti F, Dionisi AM, Mastrantonio P: Clostridium difficile isolates resistant to fluoroquinolones in Italy: emergence of PCR ribotype 018. J Clin Microbiol 2010, 48:2892-2896.
• [16]Lucado J, Gould C, Elixhauser A: Clostridium Difficile Infections (CDI) in Hospital Stays, 2009: Statistica Brief #124. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006.
• [17]Muscolo L, Folino-Gallo P: Il consumo di farmaci antibiotici in Italia: consumo territoriale ed ospedaliero. Variazioni regionali. Confronti internazionali. http://www.salute.gov.it/imgs/C_17_newsAree_1799_listaFile_itemName_3_file.pdf webcite
• [18]Zilberberg MD, Tabak YP, Sievert DM, Derby KG, Johannes RS, Sun X, McDonald LC: Using electronic health information to risk-stratify rates of Clostridium difficile infection in US hospitals. Infect Control Hosp Epidemiol 2011, 32(7):649-655.
• [19]McDonald LC, Owings M, Jernigan DB: Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006, 12:409-415.
• [20]Soler P, Nogareda F, Cano R: Rates of Clostridium difficile infection in patients discharged from Spanish hospitals, 1997–2005. Infect Control Hosp Epidemiol 2008, 29:887-889.
• [21]Baldan R, Cavallerio P, Tuscano A, Parlato C, Fossati L, Moro M, Serra R, Cirillo DM: First report of hypervirulent strain polymerase chain reaction ribotypes 027 and 078 causing severe Clostridium difficile infection in Italy. Clin Infect Dis 2010, 50:126-127.