A prevalence of Clostridium difficile-associated diarrhea in hospitalized patients (results of a Russian prospective multicenter study)

Abstract

Objective. The objective of the study was to evaluate the prevalence of Clostridium difficile-associated diarrhea (CDAD) among hospitalized patients with antibiotic-associated diarrhea (AAD) in general and by specific types of medical care and hospital units. Materials and Methods. A prospective, cross-sectional, non-interventional, multicenter study. The main inclusion criteria were: patient age of 18 years and over, hospital stay of at least 48 hours, current antibiotic therapy or antibiotic therapy within the previous 30 days, loose stools (Bristol stool types 5-7 and stool frequency ≥3 within ≤24 consecutive hours or exceeding normal for the patient), and signed informed consent form. The stool sample was transported to the local (study site) microbiology laboratory for detection of glutamate dehydrogenase (GDH) and toxins A/B using enzyme immunoassay (EIA) stool test. Results. From April 2016 through April 2017, a total of 1,245 patients from 12 large hospitals were enrolled into the study. Data on 81 patients were excluded from the analysis due to the different reasons. Data on 1,164 patients (45.2% males and 54.8% females) with the mean age of 54.9 years (range: 18 to 95 years) were analyzed. Length of hospitalization was 2 to 188 days (median of 8 days). The EIA stool test showed CDAD positive results in 21.7% (253/1,164) patients. The patients were from surgery units (546/1,164), internal medicine units (510/1,164) and intensive care units (108/1,164). The prevalence of CDAD among patients from surgery, internal medicine and intensive care units was 26.2%, 17.8% and 17.6%, respectively. Oncology, gastroenterology, septic surgery, oncohaematology and general profiles of hospital units accounted for more than 75% of all patients included; the prevalence of CDAD by those hospital units was 11.3%, 15.0%, 39.2%, 17.6%, and 27.2%, respectively. The proportion of GDH-positive and toxin A/B-negative patients by the rapid stool test result was 16.8% (196/1,164). The prevalence of CDAD varied widely between the hospitals (from 0% to 44.3%). Conclusions. The prevalence of CDAD among hospitalized patients with AAD in this study was 21.7% (95% confidence interval: 14.8%, 28.7%). The percentage of CDAD varied widely between hospitals and by specific types of medical care and hospital units

Keywords

• clostridium difficile-associated diarrhea
• antibiotic-associated diarrhea
• hospitalized patients
• enzyme immunoassay
• glutamate dehydrogenase
• toxin a
• toxin b