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Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis

Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality, mostly in frail patients. Notification is not mandatory in Italy, and data on incidence, risk of death, and recurrence are lacking. The purpose of this study was to determine CDI incidence and risk factors fo...

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Autores principales: Medaglia, Alice Annalisa, Mancuso, Alessandro, Albano, Chiara, Zinna, Giuseppe, Pipitò, Luca, Calà, Cinzia, Immordino, Rita, Rubino, Raffaella, Bonura, Silvia, Canino, Baldassare, Calamusa, Giuseppe, Colomba, Claudia, Almasio, Pier Luigi, Cascio, Antonio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215700/
https://www.ncbi.nlm.nih.gov/pubmed/37237740
http://dx.doi.org/10.3390/antibiotics12050837
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author Medaglia, Alice Annalisa
Mancuso, Alessandro
Albano, Chiara
Zinna, Giuseppe
Pipitò, Luca
Calà, Cinzia
Immordino, Rita
Rubino, Raffaella
Bonura, Silvia
Canino, Baldassare
Calamusa, Giuseppe
Colomba, Claudia
Almasio, Pier Luigi
Cascio, Antonio
author_facet Medaglia, Alice Annalisa
Mancuso, Alessandro
Albano, Chiara
Zinna, Giuseppe
Pipitò, Luca
Calà, Cinzia
Immordino, Rita
Rubino, Raffaella
Bonura, Silvia
Canino, Baldassare
Calamusa, Giuseppe
Colomba, Claudia
Almasio, Pier Luigi
Cascio, Antonio
author_sort Medaglia, Alice Annalisa
collection PubMed
description Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality, mostly in frail patients. Notification is not mandatory in Italy, and data on incidence, risk of death, and recurrence are lacking. The purpose of this study was to determine CDI incidence and risk factors for mortality and recurrence. The “ICD-9 00845” code in hospital-standardized discharged forms (H-SDF) and microbiology datasets were used to retrieve CDI cases at Policlinico Hospital, Palermo between 2013 and 2022. Incidence, ward distribution, recurrence rate, mortality, and coding rate were considered. The risk of death and recurrence was predicted through multivariable analysis. There were 275 CDIs, 75% hospital-acquired, the median time between admission and diagnosis was 13 days, and the median stay was 21 days. Incidence increased from 0.3 to 5.6% (an 18.7-fold increase) throughout the decade. Only 48.1% of cases were coded in H-SDF. The rate of severe/severe-complicated cases increased 1.9 times. Fidaxomicin was used in 17.1% and 24.7% of cases overall and since 2019. Overall and attributable mortalities were 11.3% and 4.7%, respectively. Median time between diagnosis and death was 11 days, and recurrence rate was 4%. Bezlotoxumab was administered in 64% of recurrences. Multivariable analysis revealed that only hemodialysis was associated with mortality. No statistically significant association in predicting recurrence risk emerged. We advocate for CDI notification to become mandatory and recommend coding CDI diagnosis in H-SDF to aid in infection rate monitoring. Maximum attention should be paid to preventing people on hemodialysis from getting CDI.
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spelling pubmed-102157002023-05-27 Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis Medaglia, Alice Annalisa Mancuso, Alessandro Albano, Chiara Zinna, Giuseppe Pipitò, Luca Calà, Cinzia Immordino, Rita Rubino, Raffaella Bonura, Silvia Canino, Baldassare Calamusa, Giuseppe Colomba, Claudia Almasio, Pier Luigi Cascio, Antonio Antibiotics (Basel) Article Clostridioides difficile infection (CDI) is a significant cause of morbidity and mortality, mostly in frail patients. Notification is not mandatory in Italy, and data on incidence, risk of death, and recurrence are lacking. The purpose of this study was to determine CDI incidence and risk factors for mortality and recurrence. The “ICD-9 00845” code in hospital-standardized discharged forms (H-SDF) and microbiology datasets were used to retrieve CDI cases at Policlinico Hospital, Palermo between 2013 and 2022. Incidence, ward distribution, recurrence rate, mortality, and coding rate were considered. The risk of death and recurrence was predicted through multivariable analysis. There were 275 CDIs, 75% hospital-acquired, the median time between admission and diagnosis was 13 days, and the median stay was 21 days. Incidence increased from 0.3 to 5.6% (an 18.7-fold increase) throughout the decade. Only 48.1% of cases were coded in H-SDF. The rate of severe/severe-complicated cases increased 1.9 times. Fidaxomicin was used in 17.1% and 24.7% of cases overall and since 2019. Overall and attributable mortalities were 11.3% and 4.7%, respectively. Median time between diagnosis and death was 11 days, and recurrence rate was 4%. Bezlotoxumab was administered in 64% of recurrences. Multivariable analysis revealed that only hemodialysis was associated with mortality. No statistically significant association in predicting recurrence risk emerged. We advocate for CDI notification to become mandatory and recommend coding CDI diagnosis in H-SDF to aid in infection rate monitoring. Maximum attention should be paid to preventing people on hemodialysis from getting CDI. MDPI 2023-04-30 /pmc/articles/PMC10215700/ /pubmed/37237740 http://dx.doi.org/10.3390/antibiotics12050837 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Medaglia, Alice Annalisa
Mancuso, Alessandro
Albano, Chiara
Zinna, Giuseppe
Pipitò, Luca
Calà, Cinzia
Immordino, Rita
Rubino, Raffaella
Bonura, Silvia
Canino, Baldassare
Calamusa, Giuseppe
Colomba, Claudia
Almasio, Pier Luigi
Cascio, Antonio
Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title_full Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title_fullStr Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title_full_unstemmed Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title_short Clostridioides difficile Infection in an Italian Tertiary Care University Hospital: A Retrospective Analysis
title_sort clostridioides difficile infection in an italian tertiary care university hospital: a retrospective analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215700/
https://www.ncbi.nlm.nih.gov/pubmed/37237740
http://dx.doi.org/10.3390/antibiotics12050837
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