Clostridium difficile Infections in Medical Intensive Care Units of a Medical Center in Southern Taiwan: Variable Seasonality and Disease Severity

Abstract

Critical patients are susceptible to Clostridium difficile infections (CDIs), which cause significant morbidity and mortality in the hospital. In Taiwan, the epidemiology of CDI in intensive care units (ICUs) is not well understood. This study was aimed to describe the incidence and the characteristics of CDI in the ICUs of a medical center in southern Taiwan. Adult patients with diarrhea but without colostomy/colectomy or laxative use were enrolled. Stool samples were collected with or without 5 ml alcohol and were plated on cycloserine-cefoxitin-fructose agar. C. difficile identification was confirmed by polymerase chain reaction. There were 1,551 patients admitted to ICUs, 1,488 screened, and 145 with diarrhea. A total of 75 patients were excluded due either to laxative use, a lack of stool samples, or refusal. Overall, 70 patients were included, and 14 (20%) were diagnosed with CDI, with an incidence of 8.8 cases per 10,000 patient-days. The incidence of CDI was found to be highest in March 2013 and lowest in the last quarter of 2013. The cases were categorized as the following: 5 severe, complicated, 5 severe, and 4 mild or moderate diseases. Among the 14 cases of CDI, the median patient age was 74 (range: 47–94) years, and the median time from admission to diarrhea onset was 16.5 (4–53) days. Eight cases received antimicrobial treatment (primarily metronidazole), and the time to diarrheal resolution was 11.5 days. Though 6 cases were left untreated, no patients died of CDI. The in-hospital mortality of CDI cases was 50%, similar to that of patients without CDI (46.4%; P = 1.0). We concluded that the overall incidence of CDI in our medical ICUs was low and there were variable seasonal incidences and disease severities of CDI.

Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients

“…We found that 435 of 267,871 (0.16%) critically ill patients developed CDI. This was lower than the previously reported rate (14/1488 (0.9%)) in Taiwan [ 27 ]. However, because of the different sample populations and different methodologies used, the incidence rate in the present study might be reasonable.…”

“…A dramatic and significantly higher (2–4 times) incidence of CDI was reported in the past decade in North America [ 25 , 26 ]. The reported incidence of CDI in North American and European ICUs is 0.4–4% of the ICU population [ 27 ]. We found that 435 of 267,871 (0.16%) critically ill patients developed CDI.…”

Seasonality ofClostridium difficilein the natural environment

“…A few other studies in humans and food have reported possible C. difficile seasonality. In previous studies in hospitals in Taiwan and Australia, the incidence of CDI was found to be highest in March and lowest in the last quarter of the year (Lee, Hung, Lin, Tsai, & Ko, ; Worth, Spelman, Bull, Brett, & Richards, ). A further review on CDI seasonality reports a similar seasonal pattern in the Northern and Southern hemispheres, with a peak in spring and lower frequencies in summer and autumn (Furuya‐Kanamory et al, ).…”

Prevalence and antimicrobial susceptibility pattern of toxigenic <i>Clostridium difficile</i> strains isolated in Iran

“…A comparable pattern is observed in Asia (3%) and Europe (1%) (32). Additionally, investigations have revealed that 3.6%, 3.3%, 3.3%, 2.4%, 0.9%, and 20% of CDAD in hospitalized patients of the USA, UK, Canada, China, France, and Taiwan are associated to C. difficile infection, respectively (33)(34)(35). The prevalence of CDI or CDAD has been less studied in Iran.…”