Clostridium difficile associated disease – dramatic increase in the incidence among hospitalized patients

Many publications show an incidence increase of Clostridium difficile (CD) associated disease (CDAD), affecting both in- and outpatients being these recent infections more severe and difficult to treat. The aim of this retrospective study is to evaluate the incidence and clinical impact of CDAD in patients hospitalized from the 1st January 2004 to the 31st December 2009. Suggestive clinical manifestations and at least one of the following were the inclusion criteria: CDAD compatible colonoscopy or CD positive toxin. We identified 83 cases of CDAD (32M, 51W), in a total of 9581 patients (5198M, 4383W). Age ranging from 47 to 94 years (average 79). Five patients had CDAD acquired in the community and 78 in hospital environment. The incidence of CDAD increased almost six fold between 2004 and 2009 (4.35/1000 vs. 21.63/1000), and 77.11% developed the disease during hospitalization. The disease was more frequent in women (11.64/1000 vs. 6.16/1000). All patients had undergone prior antibiotherapy. The comorbidities, number of antibiotics used, advanced age, duration of the antibiotherapy and the length of hospitalization did not seem to justify the increase in incidence and severity. In 96% the diagnosis was confirmed by the presence of Clostridium toxin and in 4% by colonoscopy. Seventy three patients (88%) were treated with metronidazole and 30% died (the department overall mortality was 13%). Probably, it was the advanced age related with the worst severity scenario which caused the high mortality in our cases