Background Diarrhoea is a symptom frequently encountered in hospitalised patients with prolonged antibiotic treatment, which suggests nosocomial infection. The main cause of diarrhoeal illness associated with antibiotics is infection with Clostridium difficile (CD), a bacteria that is frequently encountered in asymptomatic carriers. From these reasons many healthcare settings have implemented screening for Clostridium difficile infection (CDI).
Purpose To assess the prevalence of CDI and CD carriage rate in patients undergoing prolonged antibiotic treatments.
Material and methods The present study included 189 consecutive patients hospitalised in Clinical Emergency County Hospital of Craiova, Romania (SCJUC) with various comorbidities, following more than 7 days of antibiotic treatment, from which were collected stool specimens. Colonisation/infection with CD was determined by immunochromatographic screening method using kit NADAL–C. Difficile Toxins A and B Test (nal von minden GMBH, Germany) and confirmed by PCR using GeneXpert II (Cepheid, USA).
Results Antibiotic associated diarrhoea was encountered in 66 patients (34.92%). Of those, 49 (74.24%) had infection with CD. Thus the CDI rate was 49/189 (25.93%). Of the 123 patients without diarrhoea syndrome, 57 (46.34%) were asymptomatic CD carriers. CDI rate was higher in the intensive care unit (ICU) (58.90%), followed by surgical departments (50.00%) with a lower prevalence recorded in medical wards (43.75%). We observed a higher prevalence of CDI (57.24%) in elderly patients over 60 years, compared with middle aged patients (51.35%, risk ratio=1.114). Multivariate analysis showed that only diarrhoeal syndrome was a significant positive predictor for CDI (OR=3.31, p=0.001). Admission to the ICU unit, age over 60 years and male sex were non-significant positive predictors for CDI.
Conclusion CDI had a relatively high frequency in SCJUC in patients treated with antibiotics, being the leading cause of diarrhoea syndrome in these patients. The carriage rate of CD was also significantly increased. Screening for CDI contributes to detection of asymptomatic carriers and orientates therapeutic choices in hospitalised patients with enterocolitis.
References and/or acknowledgements Dubberke ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clin Infect Dis2012;55(Suppl 2):S88–92.
No conflict of interest
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