Surveillance of Clostridium difficile Infections: Results from a Six-Year Retrospective Study in Nine Hospitals of a North Italian Local Health Authority

Greta Roncarati, Laura Dallolio, Erica Leoni, Manuela Panico, Angela Zanni and Patrizia Farruggia
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Greta Roncarati: Unit of Microbiology, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, Bologna 40138, Italy
Laura Dallolio: Unit of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy
Erica Leoni: Unit of Hygiene, Public Health and Medical Statistics, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, Bologna 40126, Italy
Manuela Panico: Direction of Maggiore Hospital, Local Health Authority of Bologna, Via Largo Nigrisoli 2, Bologna 40133, Italy
Angela Zanni: Unit of Hygiene and Quality of Residential Services, Bellaria Hospital, Local Health Authority of Bologna, Via Altura 3, Bologna 40139, Italy
Patrizia Farruggia: Unit of Hygiene and Quality of Residential Services, Bellaria Hospital, Local Health Authority of Bologna, Via Altura 3, Bologna 40139, Italy

IJERPH, 2017, vol. 14, issue 1, 1-13

Abstract: Clostridium difficile is an emerging cause of healthcare associated infections. In nine hospitals of an Italian Local Health Authority the episodes of C. difficile infection (CDI) were identified using the data registered by the centralized Laboratory Information System, from 2010 to 2015. CDI incidence (positive patients for A and/or B toxins per patients-days) was analysed per year, hospital, and ward. A number of cases approximately equivalent to the mean of identified cases per year were studied retrospectively to highlight the risk factors associated to CDI and their severity. Nine hundred and forty-two patients affected by CDI were identified. The overall incidence was 3.7/10,000 patients-days, with a stable trend across the six years and the highest rates observed in smaller and outlying hospitals (up to 17.8/10,000), where the admitted patients were older and the wards with the highest incidences (long-term-care: 7.6/10,000, general medicine: 5.7/10,000) were more represented. The mean age of patients in each hospital was correlated with CDI rates. Of the 101 cases selected for the retrospective study, 86.1% were healthcare associated, 10.9% community acquired; 9.1% met the criteria for recurrent case and 23.8% for severe case of CDI. The overall mortality rate was 28.7%. Comorbidity conditions occurred in 91.1%, previous exposure to antibiotics in 76.2%, and proton pump inhibitors in 77.2%. Recurrent and severe cases were significantly associated with renal insufficiency and creatinine levels ?2 mg/dL. The survey based on the centralized laboratory data was useful to study CDI epidemiology in the different centres in order to identify possible weaknesses and plan control strategies, in particular the reinforcement of staff training, mainly targeted at compliance with contact precautions and hand hygiene.

Keywords: Clostridium difficile; healthcare associated infections; hospital surveillance (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
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