Epidemiological investigation of Clostridium difficile associated diarrhoea in a tertiary care hospital

Abstract number: 1733_261

Mela V., Dimarogona K., Pantazatou A., Rebelou D., Katsandri A., Papaparaskevas J., Avlamis A.

Objective: To investigate for epidemiological differences among patients with various underline disease severity, that were diagnosed and treated for Clostridium difficile associated diarrhoea (CDAD).

Materials and Methods: During the period March 2005-May 2006, out of a total of 640 specimens submitted for investigation of CDAD, 65 were culture-positive for C. difficile, of which 33 were also positive for toxin A and B. Culture for C. difficile was performed on cefoxitine-cycloserine-fructose agar after alcohol shock treatment of the specimen. Toxin A and B production was investigated by a commercially available enzyme immunoassay (Kytolone A+B kit, Meridian). Epidemiological and clinical information collected included: age, gender, type of ward, nosocomial acquisition of diarrhoea or not, duration of symptoms, classification of underlying disease according to Mac Cabe score (cases with score A were designated as group A, and those with scores B+C as group B), prior antimicrobial therapy or hospitalisation, CDAD treatment, and outcome. Statistical analysis was performed with the SPSS 13.0 programme using the x2 procedure.

Results: Among the 65 patients, 34 (52%) were women. The majority (45/65, 69%) were admitted in internal medicine wards, and previous hospitalisation was identified in 44 patients (68%). CDAD treatment received 40 patients (62%). Improvement was detected in 50 patients (77%). Nosocomial acquisition (>48 h from admission) was identified in 55 patients (85%) and was associated with group B cases (p = 0.001). Previous hospitalisation among group B patients was associated with positive toxin production (p = 0.036). Group B patients who received treatment for CDAD were more frequently improved than patients without treatment (p = 0.024), an association that was not detected among group A patients. Increased length of diarrhoea (>7 days) affected negatively the outcome of CDAD among group B patients (p = 0.009), but not among group A patients. Prior quinolone and prior 4th generation cephalosporin therapy was associated with increased length of diarrhoea (>7 days) among group B (p = 0.040 and 0.019, respectively) but not among group A patients.

Conclusions: Differences were detected between the two groups of patients regarding nosocomial acquisition, prior hospitalisation, prior antimicrobial therapy, length of diarrhoea, and final outcome. These differences are considered useful for optimisation of measures for prevention, control and treatment of CDAD.