PREVALENCE OF CLOSTRIDIUM DIFFICILE INFECTION IN HOSPITALIZED PATIENTS

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Abstract

Background: Over the past decade, the epidemiology of Clostridium difficile infection has shown a remarkable increase in incidence in both hospital and community settings. Up to the last time, inappropriate antibiotic usage was considered as the main cause of the infection. The growth of morbidity and mortality rate of C. difficile infection is partly due to the worldwide dissemination of new and more virulent C. difficile strains, and is associated with increase in severity and related health care costs. Aim: To study the prevalence of C. difficile infection in the department of gastroenterology. Materials and methods: The prevalence of C. difficile infection in patients with gastrointestinal diseases with diarrheal syndrome who has not received antibiotics within the previous 6 months was investigated. The studied group included 238 diarrheal patients with an inflammatory bowel disease, chronic pancreatitis with excretory pancreas insufficiency, and several other diseases. To identify C. difficile infection, A and B toxins in patients’ stool were determined using immunochromatography method. Results: The prevalence of C. difficile infection in the group studied was found to be 39.1% and didn’t significantly differ from that of patients with different diseases (ulcerative colitis – 37.2%, Crohn’s disease – 31.6%, chronic pancreatitis – 36.2%). After etiotropic therapy, complete resolution of diarrhea was obtained in majority of patients, none of them tested positive for A and B toxins. Conclusion: Taking into account high frequency of C. difficile infection in diarrheal patients in department of gastroenterology authors recommend mandatory detection of C. difficile toxins in all hospitalized patients with diarrhea in gastroenterology, therapeutic, surgical departments. 

About the authors

E. V. Volchkova

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Email: fake@neicon.ru
MD, researcher of the Department of Gastroenterology and Hepatology, MONIKI Russian Federation

E. A. Belousova

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Author for correspondence.
Email: eabelous@yandex.ru

MD, PhD, Professor, Head of the Department of Gastroenterology and Hepatology, Head of the Chair of Gastroenterology, the Faculty of Postgraduate Medical Education, MONIKI; Principal Gastroenterologist of the Moscow Region

Russian Federation

P. A. Makarchuk

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Email: fake@neicon.ru
MD, PhD, senior researcher of the Department of Gastroenterology and Hepatology, MONIKI Russian Federation

E. V. Rusanova

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Email: fake@neicon.ru

MD, PhD, Head of the Laboratory of Microbiology, MONIKI

Russian Federation

E. V. Velikanov

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Email: fake@neicon.ru

MD, PhD, leading researcher of the Department of Endoscopy, MONIKI

Russian Federation

References

  1. Kelly CP, Pothoulakis C, LaMont JT. Clostridium difficile colitis. N Engl J Med. 1994;330(4):257-62.
  2. McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, Johnson S, Gerding DN. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353(23): 2433-41.
  3. Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342(6):390-7.
  4. Elixhauser A, Jhung M. Clostridium Difficile-Associated Disease in U.S. Hospitals, 1993–2005: Statistical Brief #50. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Health Care Policy and Research (US); 2006- 2008 Apr.
  5. Kutty PK, Woods CW, Sena AC, Benoit SR, Naggie S, Frederick J, Evans S, Engel J, McDonald LC. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis. 2010;16(2):197-204.
  6. Hirschhorn LR, Trnka Y, Onderdonk A, Lee ML, Platt R. Epidemiology of community-acquired Clostridium difficile-associated diarrhea. J Infect Dis. 1994;169(1):127-33.
  7. Wilcox MH, Mooney L, Bendall R, Settle CD, Fawley WN. A casecontrol study of community-associated Clostridium difficile infection. J Antimicrob Chemother. 2008;62(2):388-96.
  8. Bauer MP, Veenendaal D, Verhoef L, Bloembergen P, van Dissel JT, Kuijper EJ. Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. Clin Microbiol Infect. 2009;15(12):1087-92.
  9. Kyne L, Warny M, Qamar A, Kelly CP. Asymptomatic carriage of Clostridium difficile and serum levels of IgG antibody against toxin A. N Engl J Med. 2000;342(6):390-7.
  10. Bartlett JG. Antibiotic-associated colitis. Dis Mon. 1984;30(15): 1-54.
  11. Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002;346(5):334-9.
  12. Kelly CP, LaMont JT. Clostridium difficile – more difficult than ever. N Engl J Med. 2008;359(18):1932-40.
  13. Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7(7):526-36.
  14. Miller MA, Hyland M, Ofner-Agostini M, Gourdeau M, Ishak M; Canadian Hospital Epidemiology Committee. Canadian Nosocomial Infection Surveillance Program. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol. 2002;23(3):137-40.
  15. Gravel D, Miller M, Simor A, Taylor G, Gardam M, McGeer A, Hutchinson J, Moore D, Kelly S, Boyd D, Mulvey M; the Canadian Nosocomial Infection Surveillance Program. Health Care-Associated Clostridium difficile Infection in Adults Admitted to Acute Care Hospitals in Canada: A Canadian Nosocomial Infection Surveillance Program Study. Clin Infect Dis. 2009;48(5):568-76.
  16. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, Monnet DL, van Dissel JT, Kuijper EJ; ECDIS Study Group. Clostridium difficile infection in Europe: a hospitalbased survey. Lancet. 2011;377(9759):63-73.
  17. Zilberberg MD, Tillotson GS, McDonald C. Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis. 2010;16(4):604-9.
  18. Nguyen GC, Kaplan GG, Harris ML, Brant SR. A national survey of the prevalence and impact of Clostridium difficile infection among hospitalized inflammatory bowel disease patients. Am J Gastroenterol. 2008;103(6):1443-50.
  19. Powell N, Jung SE, Krishnan B. Clostridium difficile infection and inflammatory bowel disease: a marker for disease extent? Gut. 2008;57(8):1183-4.
  20. Rahier JF, Magro F, Abreu C, Armuzzi A, Ben-Horin S, Chowers Y, Cottone M, de Ridder L, Doherty G, Ehehalt R, Esteve M, Katsanos K, Lees CW, Macmahon E, Moreels T, Reinisch W, Tilg H, Tremblay L, Veereman-Wauters G, Viget N, Yazdanpanah Y, Eliakim R, Colombel JF; European Crohn’s and Colitis Organisation (ECCO). Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014;8(6):443-68.
  21. Лобзин ЮВ, Захаренко СМ, Иванов ГА. Современные представления об инфекции Clostridium difficile. Клиническая микробиология и антимикробная химиотерапия. 2002;4(3): 200-32. (Lobzin YuV, Zakharenko SM, Ivanov GA. [Clostridium difficile infection: contemporary views]. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2002;4(3):200-32. Russian).
  22. Vanpoucke H, De Baere T, Claeys G, Vaneechoutte M, Verschraegen G. Evaluation of six commercial assays for the rapid detection of Clostridium difficile toxin and/or antigen in stool specimens. Clin Microbiol Infect. 2001;7(2):55-64.
  23. Ananthakrishnan AN. Detecting and treating Clostridium difficile infections in patients with inflammatory bowel disease. Gastroenterol Clin North Am. 2012;41(2):339-53.
  24. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366(9491):1079-84.
  25. Voth DE, Ballard JD. Clostridium difficile toxins: mechanism of action and role in disease. Clin Microbiol Rev. 2005;18(2):247-63.

Copyright (c) 2016 Volchkova E.V., Belousova E.A., Makarchuk P.A., Rusanova E.V., Velikanov E.V.

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