Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases

BACKGROUND: The recent emergence of Clostridium difficile infections has included this condition among top nosocomial infections, due to its incidence, complications and important fatality, as well as to significant economic costs. METHODS: A prospective surveillance study of Clostridium difficile enterocolitis cases was performed in “Victor Babeş” Infectious Diseases Hospital in Timişoara (Romania) between 01.01.2013 - 30.06.2014, to estimate the incidence and to investigate the risk factors for unfavourable outcome and relapse. Dichotomous variables were compared by the chi-square test or Fisher exact test and the Mann–Whitney U test was used for continuous variables. Risk factors for unfavourable outcome/recurrence were investigated by logistic regression. RESULTS: 210 patients who experienced 219 episodes of infection with Clostridium difficile were identified, which gives an incidence per hospital of 20.57/15.70 to 1,000 discharged patients in 2013/2014 or 17.73/14.04 to 10,000 patient-days. In 162 patients (77.14%) the evolution was favourable while in 48 (22.86%) the outcome was unfavourable. In 42 patients (20.00%) recurrence of symptoms was identified. The multivariate analysis by logistic regression identified the ATLAS score (OR = 4.97, 95% CI = 2.12 to 11.66, p <0.001), age (OR = 1.12, 95% CI = 1.00 to 1.25, p = 0.046), and the number of antibiotics after episode onset (OR = 2.692, 95% CI = 1.01 to 7.17, p = 0.047) as predictors of an unfavourable evolution, while the number of hospitalization days (OR = 1.10, 95% CI = 1.03 to 1.16, p = 0.0015) was associated with recurrence of symptoms. CONCLUSIONS: The high incidence identified in our study is explained by the endemic character of these infections in some hospitals in Timişoara, released in late 2012, and the fact that “Victor Babeş” Hospital is the only one in our area that provides treatment in all suspected or confirmed cases of this condition requiring hospitalization. The study identified the ATLAS score, age, and the number of antibiotics after episode onset as predictors of unfavourable evolution, while the number of days of hospitalization was associated with the recurrence of symptoms.