title: Clostridium difficile infection epidemiology and management: Comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in Northern Italy.
abstract: Clostridium difficile-associated disease (CDAD) is the most common infectious antibiotic-associated diarrhea and is a growing health care problem. Prevention of Clostridium difficile infection focuses on clinical and epidemiologic infection control measures.
  
  
  
  Between 2008 and 2009, we conducted a retrospective study that showed an incidence of CDAD among the highest reported in the literature. Subsequently, we developed a preventive protocol that was adopted in our hospital in 2010. We then conducted a prospective study to investigate prevalence, incidence, and mortality of CDAD and to compare the results with those of the retrospective study, evaluating adherence to preventive measures and their efficacy.
  
  
  
  In both studies, prevalence and incidence significantly increased in older patients. Crude prevalence was similar in the 2 studies. The incidence rate increased by 36%, with a significant increase only in the C and D wards. In-hospital mortality rose in both prevalent and incident cases. Regarding adhesion to hospital protocol, 77% of prevalent cases were treated with the required procedure. The highest percentage of isolated patients was achieved in C and D wards. In these wards we detected lower training hours per nurse. However, in 2013, we observed a significant decrease in incidence of CDAD and found a hospital prevalence of 0.33%.
  
  
  
  Health care personnel education could be more important than the possibility of isolating infected patients in single rooms.
authors.affiliation: Post graduate School in Public Health, Department Biomedical Sciences for Health, University of Milan, Milan, Italy. Electronic address: giulia.domeniconi@tiscali.it.
authors.forename: G
authors.initials: G
authors.lastname: Domeniconi
authors.affiliation: Post graduate School in Internal Medicine, University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Serafino
authors.affiliation: Post graduate School in Internal Medicine, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Migone De Amicis
authors.affiliation: Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Formica
authors.affiliation: Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Lanzoni
authors.affiliation: Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Maraschini
authors.affiliation: Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, University of Milan, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Sisto
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: M D
authors.initials: MD
authors.lastname: Cappellini
authors.affiliation: Internal Medicine Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Fabio
authors.affiliation: Post graduate School in Public Health, Department Biomedical Sciences for Health, University of Milan, Milan, Italy; Quality Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Castaldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004501:Education, Medical; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Clostridium difficile infection; epidemiology; management