Clostridium difficile infection: underestimation or over estimation of the problem?

Abstract

Background: C. difficile accounts for 20%–30% of cases of antibiotic-associated diarrhea and is the most commonly recognized cause of infectious diarrhea in healthcare settings. The epidemiology of Clostridium difficile infection (CDI) changed in the last years. The objectives were to evaluate the dimension of the problem in the institution and estimate the risks of CDI. Methods & Materials: We conducted a prospective study between January-September 2017. We evaluated all samples entered into the Microbiology Laboratory for the search of CDI. We used the definition of diarrhea and episodes considered mild-moderate or severe/severe-complicated, published in CDI-SHEA/IDSA guidelines 2010 Demographic data, risk factors, severity of infection, treatment and resolution were evaluated. All clinical and demographic data were extracted manually from the electronic medical record. Results: There were 285 samples, 40.70% (116) did not meet the criteria for the definition of diarrhea. In the remaining 59.3% (169), 24 episodes of CDI were documented (14.2%). Higher incidence of infection were in women (66.7%, 16/24), older than 64 years (79.2%, 19/24), use of gastric protection (70.83%, 17/24), previous hospitalization (50%; 12/24) and previous use of ATB (75%; 18/24). 70.8% (17) were mild-moderate, 25% (6) severe and one severe-complicated. The majority received simple treatment with oral metronidazole (66.67%; 16/24) with recovered in 91.7% (22/24) of the cases. In 12.5% there was recurrence. The greatest risk of CDI was the previous use of ATB (OR: 3.93; CI95% 1,46-10.33; p0.006). Conclusion: The suspicion of infection was overestimated and many of the samples analyzed didńt meet the criteria for diarrhea. The incidence of infection was 14.2%. The advanced age was one of the most important risk factors for CDI (more than 4-fold higher in older than 64y). The most important modifiable risk factor for the development of CDI was exposure to antimicrobial agents.