Epidemiological Aspects of Clostridium Difficile Infection in the Southeast Region of Romania

What is it about?

Clostridium difficile infection (CDI) in Galati county is an important public health problem, the number of cases per 100 outpatients being in the first 5, nationally. The percentage of community-associated infection in this county is higher than the national and european ones. We performed a prospective observational study on 720 patients admitted between 1.01.2017-31.12.2018 in the Clinical Hospital of Infectious Diseases „St. Cuv. Parascheva“ Galati and we analyzed comparative demographic data, risk factors, disease evolution and prognosis of a batch of 565 (78.47%) patients with healthcare facility associated infection, with a batch of 144 patients (20%) with community-associated infection. The identified type of Clostridium difficile was ribotype 027 in 93.61% of the toxigenic strains studied. The study showed that CDI predominantly affects women in urban areas. Patients with community source are younger, with less comorbidities, have episodes of illness with lower severity and better prognosis both in terms of CDI recurrence and post-CDI death. Patients with a nosocomial source are older, with multiple comorbidities, with greater exposure to antibiotic, proton pump inhibitor and recent abdominal surgery, have severe episodes of the disease and have a poorer prognosis than those with a community source.

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Why is it important?

The main source of CDI is nosocomial, associated with the intensive and / or inadequate use of antibiotics, but we observed the spread of infection in the community. The increase in the number of community cases, especially in young people, can be correlated with the easy access to the use of antibiotics and proton pump inhibitors, even without a prescription. Prolonged hospitalization, antibiotic theraphy errors and inadequate hygiene are associated with the onset of nosocomial CDI.

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