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Asensio Á, Vallejo-Plaza A, Parra LM, Ortí-Lucas R, Salcedo I, Ramos A, Cantero M. Epidemiology of Clostridioides difficile infection in hospitalized patients in Spain: An eight-year review (2012-2019). ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:125-130. [PMID: 35249672 DOI: 10.1016/j.eimce.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.
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Affiliation(s)
- Ángel Asensio
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain.
| | - Alberto Vallejo-Plaza
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Lina M Parra
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Rafael Ortí-Lucas
- Preventive Medicine Department, University Clinical Hospital of Valencia, Valencia, Spain
| | | | - Antonio Ramos
- Internal Medicine Department, Infectious Disease Unit, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Mireia Cantero
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
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Asensio Á, Vallejo-Plaza A, Parra LM, Orti-Bordas R, Salcedo I, Ramos A, Cantero M. Epidemiology of Clostridioides difficile infection in hospitalized patients in Spain: An eight-year review (2012-2019). Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00179-8. [PMID: 34024674 DOI: 10.1016/j.eimc.2021.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a disease that is potentially preventable by vaccination. A good knowledge of its epidemiology, which can change over time, is warranted for prevention purposes and to help decision-making on the use of vaccines in public health programs. The objective of the research was to determine the epidemiology of healthcare-associated CDI (HA-CDI) and community-associated CDI (CA-CDI) in hospitalized patients in Spain using point prevalence data. METHODS Point prevalence survey data on infections of hospitalized patients for years 2012-2019 were analyzed. HA-CDI and CA-CDI prevalence rates were calculated. Both HA-CDI and CA-CDI, as well as age group prevalence rates, were examined for trends. Patient comorbidities were tested for association to CDI. RESULTS The prevalence of CDI in Spanish hospitals has grown exponentially from 14.1% in 2012 to 35.9% in 2019 (cases/10.000 hospitalized patients). Almost two thirds of the cases are of nosocomial onset. This increase was observed for HA-CDI and CA-CDI at an annual rate of 1.11% (CI 95% 1.08-1.15) and 1.09% (CI 95% 1.04-1.13), respectively. Patients 50 years old or older represent 87% of the total number of cases. Patients suffering from neoplasm (OR 1.39), immunodeficiency (OR 3.26), neutropenia (OR 3.70), cirrhosis (OR 1.92) and chronic renal failure (OR 1.91) have a significant increased risk of developing CDI, after adjusting for age. CONCLUSION In Spain, the prevalence rate of both HA-CDI and CA-CDI have been increasing. Burden of CDI as well as clinical and epidemiological characteristics of CDI patients will help to support public health decision-making.
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Affiliation(s)
- Ángel Asensio
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain.
| | - Alberto Vallejo-Plaza
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Lina M Parra
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Rafael Orti-Bordas
- Preventive Medicine Department, University Clinical Hospital of Valencia, Valencia, Spain
| | | | - Antonio Ramos
- Internal Medicine Department, Infectious Disease Unit, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
| | - Mireia Cantero
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain
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Balsells E, Shi T, Leese C, Lyell I, Burrows J, Wiuff C, Campbell H, Kyaw MH, Nair H. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health 2019; 9:010407. [PMID: 30603078 PMCID: PMC6304170 DOI: 10.7189/jogh.09.010407] [Citation(s) in RCA: 150] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Clostridium difficile is a leading cause of morbidity and mortality in several countries. However, there are limited evidence characterizing its role as a global public health problem. We conducted a systematic review to provide a comprehensive overview of C. difficile infections (CDI) rates. Methods Seven databases were searched (January 2016) to identify studies and surveillance reports published between 2005 and 2015 reporting CDI incidence rates. CDI incidence rates for health care facility-associated (HCF), hospital onset-health care facility-associated, medical or general intensive care unit (ICU), internal medicine (IM), long-term care facility (LTCF), and community-associated (CA) were extracted and standardized. Meta-analysis was conducted using a random effects model. Results 229 publications, with data from 41 countries, were included. The overall rate of HCF-CDI was 2.24 (95% confidence interval CI = 1.66-3.03) per 1000 admissions/y and 3.54 (95%CI = 3.19-3.92) per 10 000 patient-days/y. Estimated rates for CDI with onset in ICU or IM wards were 11.08 (95%CI = 7.19-17.08) and 10.80 (95%CI = 3.15-37.06) per 1000 admission/y, respectively. Rates for CA-CDI were lower: 0.55 (95%CI = 0.13-2.37) per 1000 admissions/y. CDI rates were generally higher in North America and among the elderly but similar rates were identified in other regions and age groups. Conclusions Our review highlights the widespread burden of disease of C. difficile, evidence gaps, and the need for sustainable surveillance of CDI in the health care setting and the community.
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Affiliation(s)
- Evelyn Balsells
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint first authorship
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint first authorship
| | - Callum Leese
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Iona Lyell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - John Burrows
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Moe H Kyaw
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Joint last authorship
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.,Joint last authorship
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Urbina Soto L, García Ávila S, Córdoba Alonso AI, Roiz Mesones MP, Arnaiz García AM, Valero Díaz de Lamadrid MC. Clostridium difficile associated diarrhoea: An increased problem. Med Clin (Barc) 2016; 147:543-546. [PMID: 27823794 DOI: 10.1016/j.medcli.2016.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/22/2016] [Accepted: 09/08/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Clostridium difficile associated diarrhoea is a major health problem that seems to be on the increase. In our study, we analyse the changes in the incidence of this infection over the last 11 years. METHODS A descriptive study in hospitalised patients with Clostridium difficile associated diarrhoea in University Hospital Marqués de Valdecilla (Santander, Spain) from 2004 to 2014. RESULTS A total of 244 adults were identified [53% men; 66 (SD 15) years]. The cases of nosocomial acquisition (80%), with respect to community acquired Clostridium difficile infection, were older [67 (SD 15) years vs. 63 (19) years; P=.01), high comorbidity (86% vs. 75%; P=.01), use of antibiotics (95% vs. 75%; P<.001) and proton pump inhibitors (87% vs. 48% P<.001). There has been an increasing incidence of Clostridium difficile associated diarrhoea in our hospital over an 11-year period. CONCLUSION The clinical profile of patients with Clostridium difficile diarrhoea varies by place of acquisition of infection. The prevalence of this disease is increasing.
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Affiliation(s)
- Leticia Urbina Soto
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España
| | - Sara García Ávila
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España
| | - Ana Isabel Córdoba Alonso
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España
| | - M Pía Roiz Mesones
- Servicio de Microbiología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España
| | - Ana M Arnaiz García
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, España
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Rodríguez-Martín C, Serrano-Morte A, Sánchez-Muñoz LA, de Santos-Castro PA, Bratos-Pérez MA, Ortiz de Lejarazu-Leonardo R. [Identifying gaps between guidelines and clinical practice in Clostridium difficile infection]. ACTA ACUST UNITED AC 2015; 31:152-8. [PMID: 26708998 DOI: 10.1016/j.cali.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation. MATERIAL AND METHODS A retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined RESULTS A total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (P<.003). Adherence was significantly associated with clinical cure (57% vs 42%), fewer recurrences (22.2% vs 77.7%), and mortality (25% vs 75%) (P<.01). The stratification of severity of the episode, and the adequacy of antibiotic to clinical severity, need improvement. CONCLUSIONS Overall adherence with the guidelines for management of Clostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted.
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Affiliation(s)
- C Rodríguez-Martín
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - A Serrano-Morte
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - L A Sánchez-Muñoz
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - P A de Santos-Castro
- Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M A Bratos-Pérez
- Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Infección por Clostridium difficile en Medicina Interna. Observaciones. Enferm Infecc Microbiol Clin 2015; 33:367-8. [DOI: 10.1016/j.eimc.2014.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 09/16/2014] [Accepted: 10/27/2014] [Indexed: 11/18/2022]
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