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Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

ΤίτλοςPoint-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.
Publication TypeJournal Article
Year of Publication2017
AuthorsSkoutelis, A., Pefanis A., Tsiodras S., Sipsas N. V., Lelekis M., Lazanas M. C., Gargalianos P., Dalekos G. N., Roilides E., Samonis G., Maltezos E., Hatzigeorgiou D., Lada M., Metallidis S., Stoupis A., Chrysos G., Karnesis L., Symbardi S., Loupa C. V., Giamarellou H., Kioumis I., Sambatakou H., Tsianos E., Kotsopoulou M., Georgopali A., Liakou K., Perlorentzou S., Levidiotou S., Giotsa-Toutouza M., Tsorlini-Christoforidou H., Karaiskos I., Kouppari G., Trikka-Graphakos E., Ntrivala M-A., Themeli-Digalaki K., Pangalis A., Kachrimanidou M., Martsoukou M., Karapsias S., Panopoulou M., Maraki S., Orfanou A., Petinaki E., Orfanidou M., Baka V., Stylianakis A., Spiliopoulou I., Smilakou S., Zerva L., Vogiatzakis E., Belesiotou E., & Gogos C. A.
JournalPLoS One
Volume12
Issue8
Paginatione0182799
Date Published2017
ISSN1932-6203
Λέξεις κλειδιάAged, Aged, 80 and over, Anti-Bacterial Agents, Biomarkers, Clostridium difficile, Clostridium Infections, Comorbidity, Cross Infection, Diarrhea, Female, Greece, Health Facilities, Hospitalization, Hospitals, Humans, Male, Middle Aged, Odds Ratio, Population Surveillance, Prevalence, Proportional Hazards Models, Risk Factors, Sensitivity and Specificity
Abstract

BACKGROUND: The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.METHODS: There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.RESULTS: 5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).CONCLUSIONS: The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6.

DOI10.1371/journal.pone.0182799
Alternate JournalPLoS ONE
PubMed ID28813492
PubMed Central IDPMC5559069

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