Abstract
Clostridioides difficile infections are the main cause of antibiotic-related diarrhea. Most of them come in the form of healthcare-associated Clostridioides difficile infections (HA-CDI). The aim of the study was to analyze HA-CDI epidemiology and the relationship between antibiotic consumption and CDI epidemiology at St Luke’s Provincial Hospital in Tarnow, Poland. In 2012–2018, surveillance of CDI was carried out in adult surgical wards at St Luke’s Provincial Hospital. The data were collected in accordance with the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC), and the ATC/DDD system (Anatomical Therapeutic Chemical Classification System) of the World Health Organization. In total, in the study period, 51 cases of CDI involved CA-CDI (24.5%) and 147 were HA-CDIs (75.5%). The most CA-CDIs were found in the general surgery (32.6%) and urology (17.0%) wards. CA-CDI incidence was 0.7/1000 patients and for HA-CDI it was 2/1000 patients (4.4/10,000 patientdays (pds)). The highest HA-CDI incidence was in the neurosurgical departments (18/10,000 pds) and oncological surgery (8.4/10,000) pds. There was a significant positive correlation between CA-CDI and HA-CDI (correlation of 0.943, p < 0.001) and between the number of patients hospitalized and HA-CDI (correlation of 0.865, p = 0.012). The total antibiotic consumption amounted to 0.7 DDD/10,000 pds; it was the highest in the urology ward (0.84/10,000 pds) and 49.5% of the antibiotics were fluoroquinolones (0.41/10,000 pds). On the basis of regression coefficients, a positive correlation was demonstrated between the use of fluoroquinolones and the HA-CDI incidence rate. Both a high percentage of CDI cases and a high intake of antibiotics were recorded in the urology department. About half of all antibiotics were fluoroquinolones.
Highlights
Clostridioides difficile (CD) infections are a major challenge for modern medicine and healthcare infrastructures worldwide
The data were collected in accordance with the methodology provided by the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC)
A case of C. difficile infections (CDI) must meet at least one of the following criteria—(1) diarrheal stools or toxic megacolon and a positive laboratory assay for C. difficile toxin A or B in stools, or a toxin-producing C. difficile organism detected in stool via culture or other means, e.g., a positive PCR result; or (2) pseudomembranous colitis revealed by lower gastrointestinal endoscopy; or (3) colonic histopathology characteristic of C. difficile infection on a specimen obtained during endoscopy, colectomy, or autopsy
Summary
Clostridioides difficile (CD) infections are a major challenge for modern medicine and healthcare infrastructures worldwide. The limitation of the genus Clostridium to Clostridium butyricum and related species means that a lot of existing microorganisms should not be considered Clostridium sensu stricto. One such example of medical significance is C. difficile. Based on 16S rRNA gene sequence analysis, the closest relative of Clostridium difficile is Clostridium mangenotii, and both are in the Peptostreptococcaceae family, which is phylogenetically far from the members of Clostridium sensu stricto. Chemotaxonomic, and phylogenetic analyses, a new type proposed for Clostridium difficile is Clostridioides difficile [2]
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