Clostridium Difficile Infection in Hospitalized Patients at University Clinical Center Tuzla, Bosnia and Herzegovina: a 4 Year Experience

Abstract

Introduction:Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina.Goal:We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012.Methods:We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay).Results:From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%).Conclusion:Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.

Global burden of Clostridium difficile infections: a systematic review and meta-analysis

“…A total of 229 publications [2,11,12,19-244], including 14 national surveillance reports, were included from over 12 000 publications assessed for eligibility. The literature review process is summarized in the PRISMA flowchart in Figure 1 .…”

Polymerase Chain Reaction for the Detection of Toxin a ( TCD a ) and Toxin B ( TCD B ) Genes of Clostridium Difficile Isolated From Diarrhoeal Cases and Analysis of the Clinical Spectrum

“…[32] It has been shown that previous surgery could also act as a risk factor for CDI. [34] 6(12%) of our patients had undergone different types of surgery before diagnosis of CDI. Out of 50 patients, 22(44%) were males and 28(56%) were females.…”

Biological characteristics associated with virulence in Clostridioides difficile ribotype 002 in Hong Kong

“…Importantly, some of these virulence mechanisms are accountable for the clinical outcomes of CDI. For instance, higher levels of toxins [20] and sporulation rates [21] have been reported for C. difficile BI/ NAP1/027, a hypervirulent ribotype that has caused epidemic outbreaks and is prevalent across developed countries such as North America and Western Europe [22][23][24][25][26][27][28][29]. This strain can also produce the binary toxin [1], which was suggested to potentiate the toxicity of TcdA and TcdB to increase the severity of diseases [8,30,31].…”