Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: Findings from the nationwide FADOI-PRACTICE study

Cioni, Giorgio; Viale, Pierluigi; Frasson, Stefania; Cipollini, Francesco; Menichetti, Francesco; Petrosillo, Nicola; Brunati, Sergio; Spigaglia, Patrizia; Vismara, Chiara; Bielli, Alessandra; Barbanti, Fabrizio; Landini, Giancarlo; Panigada, Grazia; Gussoni, Gualberto; Bonizzoni, Erminio; Gesu, Giovanni Pietro; Costantino, A.; Masciari, R.; Amato, G.; Fontanella, A.; Gallucci, F.; Improta, L.; Poggiano, M. R.; Rabitti, P.; Uomo, G.; Civardi, G.; Confalonieri, M.; Grandi, M.; Sacchetti, C.; Baldini, T.; Cioni, G.; Miglioli, S.; Sarti, M.; Landini, M. P.; Panuccio, D.; Romboli, E.; Vocale, C.; Berti, F.; Bonito, L.; Gozzo, M. L.; Manfellotto, D.; Natili, S.; Patti, A.; Piccolo, P.; Pistella, E.; Santini, C.; Pastorelli, R.; Pellegrinotti, M.; Quaratino, C. P.; Bona, R.; Gnerre, P.; Lillo, F.; Parodi, L.; Bovero, A.; Santoriello, L.; Agnelli, F.; Colombo, F.; Gesu, G.; Lombardi, G.; Lanzetti, V.; Biagiotti, S.; Clerici, P.; Mazzone, A.; Brusco, G.; Magnani, L.; Tirella, S.; Terulla, C.; Manso, E.; Nitti, C.; Salvi, A.; Ciarambino, T.; Pepe, C.; Politi, C.; Frediani, R.; Moschella, A.; Lodolo, L.; Barasolo, G.; Bertoncelli, M. C.; Milano, F.; Campanini, M.; Molinari, G. L.; Pittau, S.; De Bernochi, A.; Giusti, M.; Montegrosso, G.; Errico, M.; Mastroianni, F.; Tauro, L.; Caddori, A.; Prasciolu, C. G.; Di Naso, C.; Romano, M.; D'Angelo, A.; Genco, L.; Mangano, G.; Arena, F.; Biagioni, C.; Cimolato, B.; Landini, G.; Nozzoli, C.; Poli, A.; Rossolini, G.; Burzigotti, F.; Francioni, S.; Lenti, S.; Galanti, I. A.; Belcari, C.; Longo, B.; Salamone, D.; Chiti, I.; Lencioni, P.; Panigada, G.; Teghini, L.; Gambacorta, M.; Perrotta, U.; Battaglia, G.; Pizzato, E.; Vian, A.; De Menis, E.; Bordignon, G.; Tramontin, P.; Doroldi, C.; Ravagnan, P.; Sartore, P.; Leoni, M.; Pauletto, P.; Rigoli, R.; Callegari, C.; Sacchetta, A.; Vendrame, A.

doi:10.1186/s12879-016-1961-9

Background: Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. Methods: PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results: Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions: Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.