Clostridium difficile Infection in Western Romania: Correlations Between Ribotype and Clinical Form One year observational retrospective study

Abstract

Clostridium difficile is a globally significant enteric pathogen with rapid emergence in the USA, Asia, Oceania and Europe. It is reported to be the leading cause of infectious diarrhea in healthcare facilities of developed nations, and the burden of disease caused by this pathogen is receiving increasing recognition. The objectives of the present study consisted in determining the incidence of the C. difficile infection during the last year, correlating the ribotype with the clinical form of disease, as well as the quantification of the importance of the ATLAS score in the evolution of enterocolitis with C. difficile. Also, the secondary objectives of the study were: observation of the pathogens circulation in cases transferred from other hospital units and correlation of the current treatment versus existing antimicrobial guidelines. We have performed an observational retrospective study of Clostridium difficile enterocolitis cases in the Hospital of Infectious Diseases and Pneumophtisiology Victor Babes Timisoara, during January 2018- December 2018. Between January and December 2018, 207 patients with C. difficile acute enterocolitis were hospitalized. The Atlas scores remain of great utility in determining the prevalence of the infection. Of the 207 hospitalized patients in 18 cases, ribotyping was positive. All the 18 ribotypes were with binary toxin (cdt) and genotype 027, a strain commonly found in the west of the country, but also in countries with neighboring borders. Compared to the previous years, there is an alarming increase in the number of cases with C. difficile infection, ribotype 027. These isolates had another characteristic that no doubt contributed to their ability to spread quickly in a healthcare environment, they produced very high levels of spores compared to other C. difficile strains.