title: Clostridium difficile infection in hospitalized patients at university clinical center tuzla, bosnia and herzegovina: a 4 year experience.
abstract: BACKGROUND
  Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina.
  
  
  OBJECTIVE
  We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012.
  
  
  METHODS
  We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay).
  
  
  RESULTS
  From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%).
  
  
  CONCLUSIONS
  Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.
authors.affiliation: Infectious Diseases Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
authors.forename: Sead
authors.initials: S
authors.lastname: Ahmetagic
authors.forename: Nermin
authors.initials: N
authors.lastname: Salkic
authors.forename: Aldina
authors.initials: A
authors.lastname: Ahmetagic
authors.forename: Amer
authors.initials: A
authors.lastname: Custovic
authors.forename: Nijaz
authors.initials: N
authors.lastname: Tihic
authors.forename: Jasmina
authors.initials: J
authors.lastname: Smajlovic
authors.forename: Humera
authors.initials: H
authors.lastname: Porobic-Jahic
keywords: Clostridium difficile infection; diarrhea.; healthcare-associated; incidence rate