TY - JOUR
T1 - Secular trends in the epidemiology of Clostridium difficile infection (CDI) at a tertiary care hospital in Barcelona, 2006–2015: A prospective observational study
AU - Larrainzar-Coghen, Thais
AU - Rodríguez-Pardo, Dolors
AU - Fernández-Hidalgo, Nuria
AU - Puig-Asensio, Mireia
AU - Pigrau, Carles
AU - Ferrer, Carmen
AU - Rodríguez, Virginia
AU - Bartolomé, Rosa
AU - Campany, David
AU - Almirante, Benito
PY - 2018/6/1
Y1 - 2018/6/1
N2 - © 2018 Elsevier Ltd 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; P = 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; P = 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; P = 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, P = 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), P < 0.001), whereas the percentage receiving vancomycin increased (1.9% vs 32.6%) (RR 17.62 (2.47–125.49), P < 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.
AB - © 2018 Elsevier Ltd 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; P = 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; P = 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; P = 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, P = 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), P < 0.001), whereas the percentage receiving vancomycin increased (1.9% vs 32.6%) (RR 17.62 (2.47–125.49), P < 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.
KW - Clostridium difficile infection
KW - Epidemiology
KW - Outcome
KW - Secular trends
U2 - 10.1016/j.anaerobe.2018.04.002
DO - 10.1016/j.anaerobe.2018.04.002
M3 - Article
VL - 51
SP - 54
EP - 60
JO - Anaerobe
JF - Anaerobe
SN - 1075-9964
ER -