Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study.
Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy.



PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy.



Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days.



Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.
Department of Internal Medicine, Pavullo nel Frignano Hospital, Modena, Italy.
Giorgio
G
Cioni
Infectious Diseases Unit, Teaching Hospital "Policlinico S. Orsola Malpighi", Alma Mater Studiorum University of Bologna, Bologna, Italy.
Pierluigi
P
Viale
Clinical Research Department, FADOI Foundation, Piazzale L. Cadorna, 15, Milan, Italy.
Stefania
S
Frasson
Internal Medicine, Hospital "Vittorio Emanuele II", Amandola, Ascoli Piceno, Italy.
Francesco
F
Cipollini
Infectious Diseases Unit, University Hospital of Pisa, Pisa, Italy.
Francesco
F
Menichetti
2nd Infectious Diseases Division, National Institute for Infectious Diseases, "Lazzaro Spallanzani" IRCCS, Rome, Italy.
Nicola
N
Petrosillo
Department of Internal Medicine, Abbiategrasso Hospital, Milan, Italy.
Sergio
S
Brunati
Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
Patrizia
P
Spigaglia
Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy.
Chiara
C
Vismara
Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy.
Alessandra
A
Bielli
Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
Fabrizio
F
Barbanti
Department of Internal Medicine, "Santa Maria Nuova" Hospital, Florence, Italy.
Giancarlo
G
Landini
Department of Internal Medicine, "S.S. Cosma e Damiano" Hospital, Pescia, Pistoia, Italy.
Grazia
G
Panigada
Clinical Research Department, FADOI Foundation, Piazzale L. Cadorna, 15, Milan, Italy. gualberto.gussoni@gmail.com.
Gualberto
G
Gussoni
Section of Medical Statistics and Biometry "GA Maccacaro", Department of Clinical Science and Community, University of Milan, Milan, Italy.
Erminio
E
Bonizzoni
Clinical Chemistry and Microbiology Laboratory, Niguarda Ca' Granda Hospital, Milan, Italy.
Giovanni Pietro
GP
Gesu
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000235:genetics / Q000472:pathogenicity; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D003967:Diarrhea / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007124:Immunoenzyme Techniques; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction
D000900:Anti-Bacterial Agents
Clostridium difficile; Incidence; Internal Medicine; Outcome; Predictors