title: Clostridium difficile infection in hospitalized patients at a Czech tertiary center: analysis of epidemiology, clinical features, and risk factors of fulminant course.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) has been increasing in incidence, with significant morbidity and mortality, and is subject to geographical and institutional variability. We aimed to characterize epidemiology and clinical manifestations of CDI in a Czech tertiary care center and to identify risk factors of fulminant course.
  
  
  METHODS
  All adult patients hospitalized with primary CDI in a 3-year period were retrospectively identified. Epidemiological and clinically descriptive data were extracted from medical records. Multivariate analysis was used to identify the risk factors of fulminant course. The relationship between incidence of CDI and antibiotic consumption was evaluated.
  
  
  RESULTS
  Overall, 183 CDI patients, median age 67 years, were enrolled. Hospital-acquired CDI was present in 85% of cases. The incidence of CDI was 1/10,000 patient-days. Hospital-acquired CDI hospital mortality was 22.4%. Severe CDI (SCDI) was identified in 15.8% of patients, with 62% mortality. SCDI patients had longer onset of symptoms to diagnosis interval compared with mild CDI (P=0.05). Multivariate analysis showed that SCDI patients were older (P=0.018), and more frequently had abnormal abdominal physical findings (P=0.001), higher inflammatory markers (P<0.001), higher creatinine (P=0.002), and lower albumin (P<0.001) than patients with mild CDI. Analysis of antibiotic consumption at departments with the highest incidence of CDI showed a trend toward higher incidence of CDI associated with penicillin use (P=0.08) and a negative correlation of CDI incidence with nitroimidazoles consumption (P=0.03).
  
  
  CONCLUSIONS
  CDI is less frequent in the conditions studied compared with literary data; however, the fulminant form has a very high mortality. Delayed recognition and treatment is a crucial determinant of the severity of CDI. The association between CDI and antibiotic consumption is less clear.
authors.affiliation: aDepartment of Internal Medicine, Division of Gastroenterology and Hepatology bDepartment of Microbiology, Charles University Medical School and Teaching Hospital, Plzen, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Balihar
authors.forename: Filip
authors.initials: F
authors.lastname: Kozak
authors.forename: Jana
authors.initials: J
authors.lastname: Kozeluhova
authors.forename: Vaclav
authors.initials: V
authors.lastname: Hejda
authors.forename: Lucie
authors.initials: L
authors.lastname: Fremundova
authors.forename: Michal
authors.initials: M
authors.lastname: Krcma
authors.forename: Lenka
authors.initials: L
authors.lastname: Geigerova
authors.forename: Tamara
authors.initials: T
authors.lastname: Bergerova
authors.forename: Martin
authors.initials: M
authors.lastname: Matejovic
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D018153:Czech Republic / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data; D042241:Early Diagnosis; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents