Secular trends in the epidemiology of Clostridium difficile infection (CDI) at a tertiary care hospital in Barcelona, 2006-2015: A prospective observational study.
Anaerobe
; 51: 54-60, 2018 Jun.
Article
em En
| MEDLINE
| ID: mdl-29655966
ABSTRACT
OBJECTIVE:
Describe secular trends in the epidemiology and outcome of Clostridium difficile infection (CDI) at a tertiary hospital.METHODS:
All consecutive primary CDI episodes in adults (January 2006-December 2015) were included. CDI was diagnosed on the presence of diarrhoea and a positive stool test for C. difficile toxin A and/or B. To define trends, a time-series analysis was performed using yearly data on demographics, clinical characteristics, management, antimicrobial treatment, and outcome of CDI. Patients were followed-up for three months after the diagnosis.RESULTS:
There were 724 CDI episodes. Over the period from 2006 to 2015, the incidence rose from 0.18 episodes/1000 admissions to 0.26 episodes (relative rate [RR] 1.43; 95%CI, 1.02-2.00; Pâ¯=â¯0.035). Median Charlson comorbidity index increased from 2 (IQR 1-3) to 4 (IQR 2-4) (RR 1.65; 95%CI, 1.12-2.41; Pâ¯=â¯0.005). Overall, 80.4% of patients received proton pump inhibitors (PPIs) prior to CDI, and the percentage of PPI discontinuations rose from 2.3% to 20.4% (RR 8.80; 95%CI 1.20-64.36; Pâ¯=â¯0.006). Management of non-Clostridium antibiotics also changed antibiotic withdrawals or switches increased from 4.2% to 29.2% (RR 7.00; 95%CI 1.68-29.15, Pâ¯=â¯0.001). Regarding CDI treatment, the percentage of patients treated with metronidazole decreased (88.9% vs 52.6%) (RR 0.59 (0.48-0.73), Pâ¯<â¯0.001), whereas the percentage receiving vancomycin increased (1.9% vs 32.6%) (RR 17.62 (2.47-125.49), Pâ¯<â¯0.001). The percentages of cures, deaths, and first recurrences did not significantly change over the 10-year period.CONCLUSIONS:
Changes in CDI management were associated with a stable prognosis (percentage of cures and first recurrences), even though affected patients had a greater number of comorbidities over time.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Clostridioides difficile
/
Infecções por Clostridium
Tipo de estudo:
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Screening_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Anaerobe
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
Espanha