Internal and Emergency Medicine

, Volume 8, Issue 8, pp 717–723 | Cite as

Epidemiology of Clostridium difficile-associated disease in internal medicine wards in northern Italy

  • Luca Mellace
  • Dario Consonni
  • Gaia Jacchetti
  • Marta Del Medico
  • Riccardo Colombo
  • Marta Velati
  • Simone Formica
  • Maria Domenica Cappellini
  • Silvana Castaldi
  • Giovanna Fabio


Clostridium difficile-associated disease (CDAD) is a growing health care problem. Elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. Few data are available on epidemiology of CDAD in Italy and no studies have focused on CDAD burden in internal medicine wards. We retrospectively analysed all CDAD cases in four internal medicine wards of a city hospital in northern Italy and reviewed the medical records of patients who developed CDAD during hospitalization. We identified 146 newly acquired cases, yielding a cumulative incidence of 2.56 per 100 hospitalizations and an incidence rate of 23.3 per 10,000 patient-days. Main risk factors were advanced age and length of hospitalization. A high proportion of CDAD patients had several comorbidities and had been treated with more than one antibiotic. The incidence is among the highest previously reported, this may be due to the characteristics of patients admitted to internal medicine wards and to the wards per se. We conclude that efforts are needed to reduce CDAD’s burden in this setting, paying attention to logistics, patients care and antibiotic use.


Clostridium difficile Italy Epidemiology Internal medicine 



The authors are grateful to the doctors and to the personnel of the wards involved in this study. We also thank Anna Maraschini and Antonella Restelli for performing laboratory testing and collecting microbiological informations.

Conflict of interest



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Copyright information

© SIMI 2012

Authors and Affiliations

  • Luca Mellace
    • 1
  • Dario Consonni
    • 2
  • Gaia Jacchetti
    • 3
  • Marta Del Medico
    • 4
  • Riccardo Colombo
    • 5
  • Marta Velati
    • 6
  • Simone Formica
    • 1
  • Maria Domenica Cappellini
    • 1
  • Silvana Castaldi
    • 3
  • Giovanna Fabio
    • 1
  1. 1.Dipartimento di Medicina Interna, Medicina Interna 1A, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanoItaly
  2. 2.Unit of Epidemiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
  3. 3.Dipartimento di Sanità Pubblica, Microbiologia, Virologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  4. 4.Medicina Interna 1B, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  5. 5.Medicina Interna 2, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly
  6. 6.Medicina d’urgenza, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversità degli Studi di MilanoMilanItaly

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