The role of antibiotics in the emergence of Clostridium difficile infections

Ciljevi istraživanja: Ispitati učestalost dokaza toksina C. difficile kod bolesnika kod kojih je postavljena sumnja na infekciju uzrokovanu C. difficile na području Požeško-slavonske županije, prikazati trendove učestalosti bolesnika s CDI na godišnjoj razini od 01. 01. 2012. g. do 31. 12. 2014. g., prikazati raspodjelu oboljelih od CDI-a po odjelima OŽB Požega, s posebnim osvrtom na prethodnu antimikrobnu terapiju i dob bolesnika, te ispitati utjecaj potrošnje antibiotika na nivou OŽB Požega. Nacrt studije: Retrospektivna studija Ispitanici i metode: Ispitivanje je obuhvatilo 728 izvanbolničkih i hospitaliziranih ispitanika čiji su uzorci poslani na mikrobiološku obradu od strane nadležnog liječnika, te su obrađeni u laboratoriju Odjela za kliničku mikrobiologiju OŽB Požega standardiziranom metodom, ELFA metodom na VIDAS instrumentu za dokaz C. difficile Toxin A i B. Za utvrđivanje razlika među proporcijama između dvaju nezavisnih uzoraka koristio se χ²-test i Fisherov egzaktni test. Za ocjenu značajnosti dobivenih rezultata odabrana je razina značajnost α = 0,05. Rezultati: Statističkom analizom nije nađena značajna razlika između hospitaliziranih i izvanbolničkih pacijenata s obzirom na pozitivnost nalaza. Promatrajući učestalost CDI-a u Požeško-slavonskoj županiji kroz navedeni trogodišnji period može se uočiti opadajući trend, 2012. g. bilo je 41%, 2013. g. 23%, dok je 2014. g. pozitivnih ispitanika bilo 19%. U istom periodu smanjena je potrošnja ciprofloksacina, koji se koristio značajno rjeđe (8,2%) od ostalih antibiotika zajedno. Značajno je više pozitivnih ispitanika starijih od 65 godina (78,9%). Zaključak: Opadajući trend nastanka CDI-a kroz navedeni trogodišnji period možemo obrazložiti smanjenom potrošnjom ciprofloksacina.Objectives: To determine the frequency of isolated C. difficile toxins in patients infected with C. difficile in Požega Slavonia County; to show the yearly frequency trend of patients with CDI from 1st January 2012 to 31st December 2014, as well as to show the distribution of the CDI patients in different clinic departments of General County Hospital Požega. Special attention is given to the previous anti-microbe therapy and the age of patients. The research also studies antibiotics consumption at GCH Požega. Study outline: retrospective study Participants and methods: The research included 728 patients, both hospitalized and external. Their samples were sent to microbiological analysis by their doctors respectively at the Department of clinical microbiology of GCH Požega. The standardized method, ELFA method on VIDAS instrument for detecting C. difficile Toxins A and B was used to analyze the samples. χ²-test and Fisher's exact test were used to determine the difference between the proportions of two independent samples. Statistical significance was marked by α = 0.05 Results: Statistical analysis did not show significant difference between the results of hospitalized and external patients considering the positivity of the tests. The frequency of isolated C. difficile toxins in Požega Slavonia County seems to be declining over the period of three studied years; in 2012 there were 41% of patients with CDI, in 2013 there were 23% of patients with CDI, and in 2014 there were 19% of patients with CDI. Ciprofloxacin was used significantly less (8.2%) than all of the other antibiotics. There is significantly higher number of CDI patients older than 65 years (78.9%). Conclusion: The declining trend of CDI patients over the period of three studied years could be the result of reduced use of ciprofloxacin