title: Surveillance of Clostridium difficile Infections: Results from a Six-Year Retrospective Study in Nine Hospitals of a North Italian Local Health Authority.
abstract: Clostridium difficileis an emerging cause of healthcare associated infections. In nine hospitals of an Italian Local Health Authority the episodes ofC. difficileinfection (CDI) were identified using the data registered by the centralized Laboratory Information System, from 2010 to 2015. CDI incidence (positive patients for A and/or B toxins per patients-days) was analysed per year, hospital, and ward. A number of cases approximately equivalent to the mean of identified cases per year were studied retrospectively to highlight the risk factors associated to CDI and their severity. Nine hundred and forty-two patients affected by CDI were identified. The overall incidence was 3.7/10,000 patients-days, with a stable trend across the six years and the highest rates observed in smaller and outlying hospitals (up to 17.8/10,000), where the admitted patients were older and the wards with the highest incidences (long-term-care: 7.6/10,000, general medicine: 5.7/10,000) were more represented. The mean age of patients in each hospital was correlated with CDI rates. Of the 101 cases selected for the retrospective study, 86.1% were healthcare associated, 10.9% community acquired; 9.1% met the criteria for recurrent case and 23.8% for severe case of CDI. The overall mortality rate was 28.7%. Comorbidity conditions occurred in 91.1%, previous exposure to antibiotics in 76.2%, and proton pump inhibitors in 77.2%. Recurrent and severe cases were significantly associated with renal insufficiency and creatinine levels ≥2 mg/dL. The survey based on the centralized laboratory data was useful to study CDI epidemiology in the different centres in order to identify possible weaknesses and plan control strategies, in particular the reinforcement of staff training, mainly targeted at compliance with contact precautions and hand hygiene.
authors.affiliation: Unit of Microbiology, Sant'Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy. greta.roncarati@ausl.bologna.it.
authors.forename: Greta
authors.initials: G
authors.lastname: Roncarati
authors.affiliation: Unit of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy. laura.dallolio@unibo.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Dallolio
authors.affiliation: Unit of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy. erica.leoni@unibo.it.
authors.forename: Erica
authors.initials: E
authors.lastname: Leoni
authors.affiliation: Direction of Maggiore Hospital, Local Health Authority of Bologna, Via Largo Nigrisoli 2, Bologna 40133, Italy. m.panico@ausl.bologna.it.
authors.forename: Manuela
authors.initials: M
authors.lastname: Panico
authors.affiliation: Unit of Hygiene and Quality of Residential Services, Bellaria Hospital, Local Health Authority of Bologna, Via Altura 3, Bologna 40139, Italy. angela.zanni@ausl.bologna.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Zanni
authors.affiliation: Unit of Hygiene and Quality of Residential Services, Bellaria Hospital, Local Health Authority of Bologna, Via Altura 3, Bologna 40139, Italy. patrizia.farruggia@ausl.bologna.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Farruggia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D062665:Epidemiological Monitoring; D005243:Feces / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D007558:Italy / Q000453:epidemiology; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Clostridium difficile; healthcare associated infections; hospital surveillance