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Hospital-acquired Clostridium difficile infection: determinants for severe disease

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Abstract

Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective analytical cross-sectional study, age (≥65 years), sex, CDI characteristics, underlying diseases, severity of comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospital-acquired CDI (mean age 74.4 years) were identified, resulting in an incidence rate of 5.7/10,000 hospital-days. A recurrent episode of diarrhoea occurred in 25 cases (18.8%) and complications including toxic megacolon, dehydration and septicaemia in 69 cases (51.9%). Four cases (3.0%) required ICU admission, one case (0.8%) surgical intervention and 22 cases (16.5%) died within the 30-day follow-up period. Variables identified to be independently associated with severe CDI were severe diarrhoea (odds ratio [OR] 3.64, 95% confidence interval [CI] 1.19–11.11, p = 0.02), chronic pulmonary disease (OR 3.0, 95% CI 1.08–8.40, p = 0.04), chronic renal disease (OR 2.9, 95% CI 1.07–7.81, p = 0.04) and diabetes mellitus (OR 4.30, 95% CI 1.57–11.76, p = 0.004). The case fatality of 16.5% underlines the importance of increased efforts in CDI prevention, in particular for patients with underlying diseases.

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria

    J. M. Wenisch

  2. Department of Infectious Disease Epidemiology, Austrian Agency for Health and Food Safety, Vienna, Austria

    D. Schmid, H.-W. Kuo, E. Simons & F. Allerberger

  3. Institute of Medical Microbiology, Infectious Diseases and Hygiene, Paracelsus Medical University, Salzburg, Austria

    F. Allerberger

  4. Fourth Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria

    V. Michl, P. Tesik & C. Wenisch

  5. Institute of Pathology and Microbiology, Kaiser Franz Josef Hospital, Vienna, Austria

    G. Tucek

  6. 4. Medizinische Abteilung mit Infektions und Tropenmedizin, SMZ-Süd-Kaiser Franz Josef Spital, Kundratstraße 3, 1100, Wien, Austria

    C. Wenisch

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  1. J. M. Wenisch
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Correspondence to C. Wenisch.

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Judith M Wenisch and Daniela Schmid contributed equally.

Informed consent: The ethical committee of the City of Vienna waived the need for informed consent.

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Wenisch, J.M., Schmid, D., Kuo, HW. et al. Hospital-acquired Clostridium difficile infection: determinants for severe disease. Eur J Clin Microbiol Infect Dis 31, 1923–1930 (2012). https://doi.org/10.1007/s10096-011-1522-5

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  • DOI: https://doi.org/10.1007/s10096-011-1522-5

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