Burden of Clostridium difficile infection between 2010 and 2013: Trends and outcomes from an academic center in Eastern Europe

Zsuzsanna Kurti, Barbara D. Lovasz, Michael D. Mandel, Zoltan Csima, Petra A. Golovics, Bence D. Csako, Anna Mohas, Lorant Gönczi, Krisztina B. Gecse, Lajos S. Kiss, M. Szathmári, P. Lakatos

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI). METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed. RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1% of all-cause hospitalizations and 4.45% of total inpatient days). The incidence of severe CDI was 12.6% (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4% (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3% within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3% of all-inpatient deaths, and 30-d mortality rate was 21.9% (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P <0.001], use of proton pump inhibitors (OR = 2.082, P <0.001), previous hospitalization within 12 mo (OR = 3.167, P <0.001), previous CDI (OR = 15.32; P <0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P <0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P <0.001), and antibiotic therapy duration was longer (P <0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ. CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.

Original languageEnglish
Pages (from-to)6728-6735
Number of pages8
JournalWorld Journal of Gastroenterology
Volume21
Issue number21
DOIs
Publication statusPublished - Jun 7 2015

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Clostridium Infections
Eastern Europe
Clostridium difficile
Inpatients
Hospitalization
Odds Ratio
Incidence
Anti-Bacterial Agents
Nephrology
Mortality
Proton Pump Inhibitors
Endocrinology
Fluoroquinolones
Hematology
Gastroenterology
Cephalosporins
Vancomycin
Therapeutics
Internal Medicine
Infection

Keywords

  • Antibiotics
  • Clostridium difficile infection
  • Hospitalization
  • Proton pump inhibitors

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Burden of Clostridium difficile infection between 2010 and 2013 : Trends and outcomes from an academic center in Eastern Europe. / Kurti, Zsuzsanna; Lovasz, Barbara D.; Mandel, Michael D.; Csima, Zoltan; Golovics, Petra A.; Csako, Bence D.; Mohas, Anna; Gönczi, Lorant; Gecse, Krisztina B.; Kiss, Lajos S.; Szathmári, M.; Lakatos, P.

In: World Journal of Gastroenterology, Vol. 21, No. 21, 07.06.2015, p. 6728-6735.

Research output: Contribution to journalArticle

Kurti, Z, Lovasz, BD, Mandel, MD, Csima, Z, Golovics, PA, Csako, BD, Mohas, A, Gönczi, L, Gecse, KB, Kiss, LS, Szathmári, M & Lakatos, P 2015, 'Burden of Clostridium difficile infection between 2010 and 2013: Trends and outcomes from an academic center in Eastern Europe', World Journal of Gastroenterology, vol. 21, no. 21, pp. 6728-6735. https://doi.org/10.3748/wjg.v21.i21.6728
Kurti, Zsuzsanna ; Lovasz, Barbara D. ; Mandel, Michael D. ; Csima, Zoltan ; Golovics, Petra A. ; Csako, Bence D. ; Mohas, Anna ; Gönczi, Lorant ; Gecse, Krisztina B. ; Kiss, Lajos S. ; Szathmári, M. ; Lakatos, P. / Burden of Clostridium difficile infection between 2010 and 2013 : Trends and outcomes from an academic center in Eastern Europe. In: World Journal of Gastroenterology. 2015 ; Vol. 21, No. 21. pp. 6728-6735.
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abstract = "AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI). METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed. RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1{\%} of all-cause hospitalizations and 4.45{\%} of total inpatient days). The incidence of severe CDI was 12.6{\%} (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4{\%} (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3{\%} within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3{\%} of all-inpatient deaths, and 30-d mortality rate was 21.9{\%} (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P <0.001], use of proton pump inhibitors (OR = 2.082, P <0.001), previous hospitalization within 12 mo (OR = 3.167, P <0.001), previous CDI (OR = 15.32; P <0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P <0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P <0.001), and antibiotic therapy duration was longer (P <0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ. CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.",
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T2 - Trends and outcomes from an academic center in Eastern Europe

AU - Kurti, Zsuzsanna

AU - Lovasz, Barbara D.

AU - Mandel, Michael D.

AU - Csima, Zoltan

AU - Golovics, Petra A.

AU - Csako, Bence D.

AU - Mohas, Anna

AU - Gönczi, Lorant

AU - Gecse, Krisztina B.

AU - Kiss, Lajos S.

AU - Szathmári, M.

AU - Lakatos, P.

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N2 - AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI). METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed. RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1% of all-cause hospitalizations and 4.45% of total inpatient days). The incidence of severe CDI was 12.6% (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4% (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3% within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3% of all-inpatient deaths, and 30-d mortality rate was 21.9% (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P <0.001], use of proton pump inhibitors (OR = 2.082, P <0.001), previous hospitalization within 12 mo (OR = 3.167, P <0.001), previous CDI (OR = 15.32; P <0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P <0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P <0.001), and antibiotic therapy duration was longer (P <0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ. CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.

AB - AIM: To analyze the incidence and possible risk factors in hospitalized patients treated with Clostridium difficile infection (CDI). METHODS: A total of 11751 patients were admitted to our clinic between 1 January 2010 and 1 May 2013. Two hundred and forty-seven inpatients were prospectively diagnosed with CDI. For the risk analysis a 1:3 matching was used. Data of 732 patients matched for age, sex, and inpatient care period and unit were compared to those of the CDI population. Inpatient records were collected from an electronic hospital database and comprehensively reviewed. RESULTS: Incidence of CDI was 21.0/1000 admissions (2.1% of all-cause hospitalizations and 4.45% of total inpatient days). The incidence of severe CDI was 12.6% (2.63/1000 of all-cause hospitalizations). Distribution of CDI cases was different according to the unit type, with highest incidence rates in hematology, gastroenterology and nephrology units (32.9, 25 and 24.6/1000 admissions, respectively) and lowest rates in 1.4% (33/2312) in endocrinology and general internal medicine (14.2 and 16.9/1000 admissions) units. Recurrence of CDI was 11.3% within 12 wk after discharge. Duration of hospital stay was longer in patients with CDI compared to controls (17.6 ± 10.8 d vs 12.4 ± 7.71 d). CDI accounted for 6.3% of all-inpatient deaths, and 30-d mortality rate was 21.9% (54/247 cases). Risk factors for CDI were antibiotic therapy [including third-generation cephalosporins or fluoroquinolones, odds ratio (OR) = 4.559; P <0.001], use of proton pump inhibitors (OR = 2.082, P <0.001), previous hospitalization within 12 mo (OR = 3.167, P <0.001), previous CDI (OR = 15.32; P <0.001), while presence of diabetes mellitus was associated with a decreased risk for CDI (OR = 0.484; P <0.001). Treatment of recurrent cases was significantly different from primary infections with more frequent use of vancomycin alone or in combination (P <0.001), and antibiotic therapy duration was longer (P <0.02). Severity, mortality and outcome of primary infections and relapsing cases did not significantly differ. CONCLUSION: CDI was accounted for significant burden with longer hospitalization and adverse outcomes. Antibiotic, PPI therapy and previous hospitalization or CDI were risk factors for CDI.

KW - Antibiotics

KW - Clostridium difficile infection

KW - Hospitalization

KW - Proton pump inhibitors

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