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Clostridium difficile infection in hospitalized patients at a Czech tertiary center: analysis of epidemiology, clinical features, and risk factors of fulminant course

Balihar, Karela; Kozak, Filipa; Kozeluhova, Janaa; Hejda, Vaclava; Fremundova, Luciea; Krcma, Michala; Geigerova, Lenkab; Bergerova, Tamarab; Matejovic, Martina

European Journal of Gastroenterology & Hepatology: August 2014 - Volume 26 - Issue 8 - p 880–887
doi: 10.1097/MEG.0000000000000139
Original Articles: Gastrointestinal Infection

Objective Clostridium difficile infection (CDI) has been increasing in incidence, with significant morbidity and mortality, and is subject to geographical and institutional variability. We aimed to characterize epidemiology and clinical manifestations of CDI in a Czech tertiary care center and to identify risk factors of fulminant course.

Methods All adult patients hospitalized with primary CDI in a 3-year period were retrospectively identified. Epidemiological and clinically descriptive data were extracted from medical records. Multivariate analysis was used to identify the risk factors of fulminant course. The relationship between incidence of CDI and antibiotic consumption was evaluated.

Results Overall, 183 CDI patients, median age 67 years, were enrolled. Hospital-acquired CDI was present in 85% of cases. The incidence of CDI was 1/10 000 patient-days. Hospital-acquired CDI hospital mortality was 22.4%. Severe CDI (SCDI) was identified in 15.8% of patients, with 62% mortality. SCDI patients had longer onset of symptoms to diagnosis interval compared with mild CDI (P=0.05). Multivariate analysis showed that SCDI patients were older (P=0.018), and more frequently had abnormal abdominal physical findings (P=0.001), higher inflammatory markers (P<0.001), higher creatinine (P=0.002), and lower albumin (P<0.001) than patients with mild CDI. Analysis of antibiotic consumption at departments with the highest incidence of CDI showed a trend toward higher incidence of CDI associated with penicillin use (P=0.08) and a negative correlation of CDI incidence with nitroimidazoles consumption (P=0.03).

Conclusion CDI is less frequent in the conditions studied compared with literary data; however, the fulminant form has a very high mortality. Delayed recognition and treatment is a crucial determinant of the severity of CDI. The association between CDI and antibiotic consumption is less clear.

aDepartment of Internal Medicine, Division of Gastroenterology and Hepatology

bDepartment of Microbiology, Charles University Medical School and Teaching Hospital, Plzen, Czech Republic

Correspondence to Karel Balihar, MD, Ist Medical Department, Division of Gastroenterology and Hepatology, Charles University Medical Faculty and Teaching Hospital, Alej Svobody 80, Pilsen 304 60, Czech Republic Tel: +420 720 375 344; fax: +420 377 103 381; e-mail:

Received March 12, 2014

Accepted May 12, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins