Hospital-acquired Clostridium difficile infection: determinants for severe disease
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- Wenisch, J.M., Schmid, D., Kuo, HW. et al. Eur J Clin Microbiol Infect Dis (2012) 31: 1923. doi:10.1007/s10096-011-1522-5
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Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective analytical cross-sectional study, age (≥65 years), sex, CDI characteristics, underlying diseases, severity of comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospital-acquired CDI (mean age 74.4 years) were identified, resulting in an incidence rate of 5.7/10,000 hospital-days. A recurrent episode of diarrhoea occurred in 25 cases (18.8%) and complications including toxic megacolon, dehydration and septicaemia in 69 cases (51.9%). Four cases (3.0%) required ICU admission, one case (0.8%) surgical intervention and 22 cases (16.5%) died within the 30-day follow-up period. Variables identified to be independently associated with severe CDI were severe diarrhoea (odds ratio [OR] 3.64, 95% confidence interval [CI] 1.19–11.11, p = 0.02), chronic pulmonary disease (OR 3.0, 95% CI 1.08–8.40, p = 0.04), chronic renal disease (OR 2.9, 95% CI 1.07–7.81, p = 0.04) and diabetes mellitus (OR 4.30, 95% CI 1.57–11.76, p = 0.004). The case fatality of 16.5% underlines the importance of increased efforts in CDI prevention, in particular for patients with underlying diseases.