title: Burden of Clostridium difficile infection between 2010 and 2013: Trends and outcomes from an academic center in Eastern Europe.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kurti
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Barbara D
authors.initials: BD
authors.lastname: Lovasz
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mandel
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Csima
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Golovics
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Bence D
authors.initials: BD
authors.lastname: Csako
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Anna
authors.initials: A
authors.lastname: Mohas
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Lorant
authors.initials: L
authors.lastname: Gönczi
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Krisztina B
authors.initials: KB
authors.lastname: Gecse
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Lajos S
authors.initials: LS
authors.lastname: Kiss
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Miklos
authors.initials: M
authors.lastname: Szathmari
authors.affiliation: 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, Miklos Szathmari, Peter L Lakatos, 1 Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016360:Clostridioides difficile / Q000302:isolation & purification / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D011379:Prognosis; D011446:Prospective Studies; D065840:Protective Factors; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Antibiotics; Clostridium difficile infection; Hospitalization; Proton pump inhibitors