Prevalence and predictors for the development of Clostridium difficile infection in patients of the therapeutic hospital

Abstract

Purpose of the study : to assess the prevalence and risk factors for the development of Clostridium difficile infection in patients in of the therapeutic clinical in a multi-specialiry hospital. Materials and methods . A retrospective analysis was made of 110 patients, who were hospitalized in therapeutic department in Municipal Autonomus Institution «City Clinical Hospital № 40» in Yekaterinburg from 2014 to 2015 years, who had diarrhea developed on the background of antibacterial therapy. According to the results of the data obtained through studies of coprofiltrates on Clostridium difficile, the patients were divided into 2 groups: 60 patients with a positive result, and 50 patients with a negative result. Results . The proportion of patients with CD-infection in the department of therapy in MAI «City Clinical Hospital № 40», according to the data of the 2014–2015 years, amounted to 0,42%. The predictors of the risk of the development of CD-infection in patients are age of patients older than 65 years old (OR = 4,33, 95% CI 1,15 to 16,20, p = 0,028), Charlson comorbidity index of 2 points or more (OR = 3,05, 95% CI 1,29 to 7,23, p = 0,016), the presence of anemia (OR = 2,32, 95% CI 1,07 to 5,02, p = 0,048), chronic dialyzing of patients with chronic renal failure (OR = 8,64, 95% CI 1,05 to 70,81, p = 0,020), the stay of patients in hospital more than 5 days (OR = 3,50, 95% CI 1,57 to 7,75, p = 0,003) and hospitalization in the ICU lasting more than 1 day (OR = 9,80, 95% CI 1,20 to 79,47, p = 0,011), the use PPI (OR = 2,82, 95% CI 1,12 to 7,11, p = 0,041), holding antibacterial therapy for more than 10 days (OR = 39,62, 95% CI 10,85 to 144, 71, p < 0,001), holding more than 1 course of antibiotic therapy (OR = 2,85, 95% CI 1,20 to 6,76, p = 0,026). The logistic regression analysis showed the connection between the use of cephalosporins of the third generation (OR = 6,55, 95% CI 1,18 to 36,40, p = 0,032), the duration of the use of antibiotics (OR = 1,89, 95% CI 1,50 to 2,38, р < 0,001) and the risk of CD-infection. Conclusions . The independent risk factors for the development of CD-associated diarrhea in patients in of the therapeutic clinical of a multi-speciality hospital in Russia are the use of the 3 rd generation cephalosporins and a long-term course of antibacterial therapy.