title: Risk factors forClostridium difficileinfection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case-control study.
abstract: BACKGROUND
  The objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA)Clostridium difficileinfection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital.
  
  
  METHODS
  Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI.
  
  
  RESULTS
  The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P= 0.007, OR: 10.62, 95% CI: 1.93-58.4), the admission to intensive care unit (P= 0.004, OR:3.00, 95% CI:1.41-6.40), and the administration of 3rd generation cephalosporins (P= 0.014, OR:2.27, 95% CI:1.18-4.39). Patients with HA CDI had significantly higher in-hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84-43.43).
  
  
  CONCLUSIONS
  CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.
authors.affiliation: Department of Nosocomial Infections Control, Military Medical Academy, 11 000 Belgrade, Serbia.|Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Šuljagić
authors.affiliation: Institute of Epidemiology, Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Miljković
authors.affiliation: Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.|Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Srđan
authors.initials: S
authors.lastname: Starčević
authors.affiliation: Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.|Clinic for Plastic Surgery and Burns, Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Stepić
authors.affiliation: Faculty of Medicine of Military Medical Academy University of Defence, 11000 Belgrade, Serbia.|Clinic for General Surgery, Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Kostić
authors.affiliation: Institute of Microbiology Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Dragutin
authors.initials: D
authors.lastname: Jovanović
authors.affiliation: Sector for Pharmacy, Military Medical Academy, 11 000 Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Brusić-Renaud
authors.affiliation: Faculty of Medicine, University of East Sarajevo, 73300 Foča, Republic of Srpska, Bosnia and Herzegovina.
authors.forename: Biljana
authors.initials: B
authors.lastname: Mijović
authors.affiliation: Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Šipetić-Grujičić
keywords: Clostridium difficile; In-hospital mortality; Incidence; Risk factors; Surgical patients