Epidemiological and clinical features of patients hospitalized due to Clostridium difficile - associated diarrhea

UVOD: Dijareja uzrokovana bakterijom Clostridium difficile je jedna od češćih neželjenih posljedica primjene antibiotske terapije, no malo se zna o odnosu epidemioloških okolnosti razbolijevanja i kliničke težine bolesti te ishoda liječenja. ----- CILJ: Opisati epidemiološka i klinička obilježja bolesti te utvrditi odnos epidemioloških okolnosti razbolijevanja i kliničke težine bolesti i ishoda liječenja u bolesnika s Clostridium difficile infekcijom (CDI). ----- BOLESNICI I METODE: Radi se o retrospektivnom deskriptivnom istraživanju provedenom na bolesnicima oba spola i svih dobi hospitalno liječenim zbog dijareje uzrokovane laboratorijski potvrđenom CDI u razdoblju od 2013. – 2016. godine u Klinici za infektivne bolesti „Dr. Fran Mihaljević“, Zagreb. U statističkoj obradi podataka korištena je metoda linearne regresije, hi-kvadrat test, studentov t-test i njegove neparametarske inačice u slučaju odstupanja podataka od normalne distribucije. ----- REZULTATI: Od 776 bolesnika s CDI njih je 76% imalo CDI povezanu sa zdravstvenom skrbi, 16% je imalo izvanbolnički stečenu infekciju, a u 8% bolesnika se epidemiološke okolnosti razbolijevanja nisu mogle utvrditi. Udio bolesnika s CDI povezanom sa zdravstvenom skrbi je u promatranom razdoblju značajno rastao u odnosu na bolesnike s izvanbolnički stečenom CDI (p=0.0395). Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali statistički značajno veće vrijednosti maksimalne tjelesne temperature (prosjek 37,99 vs. 37,21), veći broj stolica u 24 sata (prosjek 9,14 vs. 5,83), češću pojavu renalne insuficijencije (19,2 vs. 5,7%) i češće prisutne ostale komplikacije (8,2 vs. 2,5%). Ti su bolesnici imali statistički značajno veće vrijednosti leukocita u perifernoj krvi (prosjek 15,51 vs. 13,64), niže vrijednosti albumina (prosjek 28,29 vs. 32,82) te su u njih vrijednosti kreatinina češće bile veće od 1,5x u odnosu na bazalne vrijednosti (33,2 vs. 15,1%). U njih je bio značajno veći McCabe skor (1.57 vs. 1.13) i ATLAS skor (4.05 vs. 1.85). Također, navedeni bolesnici su bili statistički značajno duže hospitalizirani (prosjek 14,83 vs. 10,13 dana) te je kod njih smrtni ishod bio značajno češći (11,7 vs. 3,3%) u odnosu na bolesnike s izvanbolnički stečenom CDI. ----- ZAKLJUČAK: U promatranom razdoblju je među hospitalno liječenim bolesnicima zabilježen značajan trend rasta udjela pacijenata koji su imali C. difficile infekciju povezanu sa zdravstvenom skrbi u periodu od 2013. – 2016. Bolesnici s CDI povezanom sa zdravstvenom skrbi su imali klinički težu bolest i lošiji ishod od bolesnika s izvanbolničkom CDI.BACKGROUND: Clostridium difficile-associated diarrhea is one of the most common unintended consequences of the administration of antibiotics and the correlation between epidemiological circumstances of acquisition and severity of illness and its outcome is not well known. ----- OBJECTIVE: To determine epidemiological and clinical features of C. difficile infection (CDI) and to assess the relationship between the epidemiological circumstances of acquisition and severity of illness and its outcome. ----- PATIENTS AND METHODS: This is a retrospective descriptive study that includes patients of both genders and all age groups hospitalized and treated for CDI with laboratory detected infection from 2013 to 2016 at University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb. Linear regression analysis, Chi-square test, Student t-test are used to compare mean values and non-parametric tests are used if distribution is not normal. ----- RESULTS: Of 776 patients 76% had healthcare-associated C. difficile infection, 16% had community-associated C. difficile infection and 8% had undetermined association. Proportion of the patients with healthcare-associated C. difficile infection significantly increased compared to proportion of patients with community-associated infection over the study period (p=0.0395). Patients with healthcare-associated C. difficile infection had significantly higher maximum body temperature (mean 37,99 vs. 37,21), more stools in 24 hours (mean 9,14 vs. 5,83), had more often renal impairment (19,2% vs. 5,7%) and had more often other complications (8,2 vs. 2,5%). Patients with healthcare-associated C. difficile infection had significantly more elevated leukocyte count (mean 15,51 vs. 13,64), lower serum albumin (mean 28,29 vs. 32,82) and had more often ˃50% increase in baseline serum creatinine level (33,2 vs. 15,1%). Patients with healthcare-associated CDI had significantly higher McCabe score (1.57 vs. 1.13) and ATLAS score (4.05 vs. 1.85). Also, they had longer length of stay in hospital (mean 14,83 vs. 10,13 days) and higher mortality rates (11,7 vs. 3,3%) when compared to patients with community-associated C. difficile infection. ----- CONCLUSIONS: There is a significant increase in proportion of healthcare-associated C. difficile cases from 2013 – 2016. Patients with healthcare-associated CDI had more severe illness and worse outcome than patients with community-associated CDI