title: Clostridium difficile infection: a Serbian single-center experience.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. Severity of CDI is associated with advanced age and co-morbidities. The clinical spectrum varies from mild watery diarrhea to severe fulminant pseudomembranous colitis with complications.
  
  
  METHODS
  This study conducted over a six-year period (2008 to 2013) included 510 patients treated at the University Hospital for Infectious and Tropical Diseases in Belgrade, Serbia. In patients with a history of previous hospitalization and/or treatment with antimicrobial agents who developed diarrhea, the diagnosis was established with rapid tests for C. difficile toxin A and B and by stool culture for C. difficile (454 patients) or by endoscopic examination and histological analyses of the biopsy samples taken from the colonic mucosa (56 patients).
  
  
  RESULTS
  The mean age of patients was 67.71±13.34 years. A total of 67.8% patients were older than 65 years. Over half (58.7%) of the patients were female. 93% had been previously hospitalized and/or had surgical interventions, during which they had been treated with antibiotics. In the clinical presentation spectrum, pseudomembranous colitis occurred in 51.0%. The mean duration of illness after the introduction of specific antibiotic therapy was 7.10 ± 4.88 days. Complications developed in 14 patients. The disease relapsed in 43 (8.4%). Thirty-two (6.3%) patients died, mostly due to co-morbidities.
  
  
  CONCLUSIONS
  CDI is the most important cause of hospital-acquired diarrhea in Serbia. The disease mainly affects elderly patients with co-morbidities. The incidence of complications is low and prognosis is age dependent and related to pre-existing diseases.
authors.affiliation: Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia. milos.korac@med.bg.ac.rs.
authors.forename: Milos
authors.initials: M
authors.lastname: Korac
authors.forename: Ivana
authors.initials: I
authors.lastname: Milosevic
authors.forename: Marko
authors.initials: M
authors.lastname: Markovic
authors.forename: Natasa
authors.initials: N
authors.lastname: Popovic
authors.forename: Milena
authors.initials: M
authors.lastname: Ilic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Markovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Nikolic
authors.forename: Djordje
authors.initials: D
authors.lastname: Jevtovic
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007413:Intestinal Mucosa / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D055771:Serbia / Q000453:epidemiology; D055815:Young Adult