Epidemiological and microbiological characterization of Clostridioides diffcile (Clostridium difficile) infection in a University Hospital Centre Split in 2017

Cilj istraživanja: Cilj istraživanja je odrediti epidemiološku i mikrobiološku osnovu Clostridioides difficile (Clostridium difficile) infekcija (CDI) u Kliničkom bolničkom centru (KBC) Split u razdoblju od 1. siječnja do 31. prosinca 2017. godine. Materijali i metode: U ovom retrospektivnom istraživanju korišteni su podatci iz pismohrane Kliničkog zavoda za mikrobiologiju i parazitologiju KBC-a Split. Uključeni su svi pacijenti s prvom epizodom CDI kojima je u razdoblju praćenja dokazan toksigeni soj C. difficile iz uzorka stolice. Analizirani su demografski podatci pacijenata i mikrobiološke osobitosti toksigenih sojeva C. difficile. Zabilježeni su slučajevi ponavljajućih infekcija u istog pacijenta, ali bez dodatne karakterizacije C. difficile sojeva u tim epizodama. Statistički značajna razlika pojavnosti CDI među spolovima, pacijentima starijim i mlađim od 65 godina, izvanbolničkim i bolničkim pacijentima te toksigenim sojevima C. difficile sa i bez aktivne produkcije toksina, ispitivana je hi kvadrat testom, na razini značajnosti p < 0,05. Rezultati: Od ukupno 519 bakterijskih patogena dokazanih u uzorcima stolice, C. difficile je bio najučestaliji (71%). Primarnu C. difficile infekciju je imalo 370 pacijenata, dok su klinički i mikrobiološki potvrđenu rekurentnu infekciju imala 54 (15%) pacijenta. Od ukupno 370 pacijenata, njih 236 (64%) su bili bolnički pacijenti, a 134 (36%) izvanbolnički pacijenti u trenutku dijagnosticiranja CDI. Među bolničkim pacijentima, najveći broj je bio liječen na Internoj klinici (40%), u jedinicama intenzivnog liječenja (28%) i Infektološkoj klinici (17%). Žena je bilo 218 (59%) što je značajno više u odnosu na muškarce (152 pacijenta, 41%). Značajno više je bilo pacijenata starijih od 65 godina (222 pacijenta, 62%), u odnosu na ukupan broj muškaraca i žena mlađih od 65 godina (134 pacijenta, 38%). Specifičnu terapiju za liječenje CDI (metronidazol ili vankomicin) u trenutku dijagnosticiranja bolesti, primalo je 29 (40%) pacijenata. Aktivna proizvodnja toksina je dokazana u 291 uzorak stolice od ukupno 370 primarnih slučajeva CDI. Od toga je u 32 (9%) uzorka dokazan samo toksin A, u 18 (5%) uzoraka samo toksin B, dok je u 241 (65%) uzorak dokazana proizvodnja oba toksina (A i B). U preostalih 79 uzoraka (21%), dokazan je toksigeni soj C. difficile bez aktivne produkcije toksina. Zaključak: Clostridioides difficile (Clostridium difficile) je najčešći bakterijski uzročnik proljeva u KBC-u Split u vremenu trajanja istraživanja. Simptomatska Clostridioides difficile infekcija je najčešća u bolničkih pacijenata starijih od 65 godina, a žene obolijevaju češće od muškaraca. CDI najčešće uzrokuju toksigeni sojevi s aktivnom proizvodnjom toksina.Aim of the study: Aim of the present study is to determine the epidemiological and microbiological basis of Clostridioides difficile (Clostridium difficile) infection (CDI) in a University Hospital of Split from 1 January to 31 December 2017. Material and methods: Data base of the Department of Clinical Microbiology was retrospectively examined and all patients with a first episode of CDI were enrolled in the study. Patients demographic data and microbiological characteristics of C. difficile strains were analyzed. Cases of recurrent infections were recorded without additional characterization of C. difficile strains. Chi-square (χ2) test was used to examine significant differences among demographic data (sex, age, hospital and community onset) and toxigenic C. difficile strais with and without active production of toxins. Results: In total, 519 different bacterial pathogens were found inpatients stool samples. Among them, C. difficile was the most frequent (71%). Primary C. difficile infection occured in 370 patients, while clinicaly and microbiologically confirmed recurrent infection had 54 (15%) of them. Majority ofinfections, 236/370 (64%) had hospital occurence (HO-CDI), while 134/370 (36%) infections occured in community. Among hospitalised patients, majority were located atthe Department for internal medicine (40%), Intensive care units (28%) and Department for infectious diseases (17%). Proportion of female patients (218/370, 59%) was significantly higher in comparison to male (152/370, 41%). Significantly more patients were older than 65 (222/356, 62%) compared to patients aged under 65 (134/356, 38%). Twenty eight (40%) patients were receiving specific therapy for CDI (metronidazole or vancomycin) at the time of diagnosis. Active toxin production was recorded in 291 of 370 positive stool samples. Only toxin A production was detected in 32 (9%) positive samples, only toxin B production in 18 (5%) positive samples, while production of both toxins (A and B) was proven in 241 (65%) positive samples. In the remaining 79 positive stool samples (21%), toxigenic C. difficile strain without active production of toxins was detected. Conclusion: Clostridioides difficile (Clostridium difficile) is the most common bacterial cause of diarrhea in University Hospital of Split during the study period. C. difficile infections (CDI) occured mostly among hospital patients older than 65. Female patients were far more affected than male. Majority of CDI were caused by toxigenic C. difficile strain with active toxin production