Secular trends in the epidemiology of Clostridium difficile infection (CDI) at a tertiary care hospital in Barcelona, 2006–2015: A prospective observational study
Abstract Objective Describe secular trends in the epidemiology and outcome of Clostridium difficile infection (CDI) at a tertiary hospital. Methods All consecutive primary CDI episodes in adults (January 2006–December 2015) were included. CDI was diagnosed on the presence of diarrhoea and a positive stool test for C. difficile toxin A and/or B. To define trends, a time-series analysis was performed using yearly data on demographics, clinical characteristics, management, antimicrobial treatment, and outcome of CDI. Patients were followed-up for three months after the diagnosis. Results There were 724 CDI episodes. Over the period from 2006 to 2015, the incidence rose from 0.18 episodes/1000 admissions to 0.26 episodes (relative rate [RR] 1.43; 95%CI, 1.02–2.00; P = 0.035). Median Charlson comorbidity index increased from 2 (IQR 1–3) to 4 (IQR 2–4) (RR 1.65; 95%CI, 1.12–2.41; P = 0.005). Overall, 80.4% of patients received proton pump inhibitors (PPIs) prior to CDI, and the percentage of PPI discontinuations rose from 2.3% to 20.4% (RR 8.80; 95%CI 1.20–64.36; P = 0.006). Management of non- Clostridium antibiotics also changed: antibiotic withdrawals or switches increased from 4.2% to 29.2% (RR 7.00; 95%CI 1.68–29.15, P = 0.001). Regarding CDI treatment, the percentage of patients treated with metronidazole decreased (88.9% vs 52.6%) (RR 0.59 (0.48–0.73), P P Conclusions Changes in CDI management were associated with a stable prognosis (percentage of cures and first recurrences), even though affected patients had a greater number of comorbidities over time. Highlights Annual incidence of new CDI cases per 1000 admissions increased along the study period. Changes in CDI management, such as control of PPIs and non-CD antibiotic use. Patients tended to have a larger number of comorbidities over the 10-year period studied. Clostridium difficile treatment changes have been made in accordance with the recently published treatment guidelines. Stable cure and relapse rates observed in patients with an increasingly larger number of comorbidities.
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