Volume 14 Supplement 7

Proceedings of the 10th Edition of the Scientific Days of the National Institute for Infectious Diseases "Prof Dr Matei Bals"

Open Access

Clinical and microbiological characterization of Clostridium difficile infection in Romania (2013-2014); a hospital-based study

  • Gabriel Adrian Popescu1, 2Email author,
  • Roxana Serban3,
  • Adriana Pistol3,
  • Andreea Niculcea3,
  • Andreea Preda3,
  • Daniela Lemeni4,
  • Ioana Macovei4,
  • Monica Popoiu2,
  • Cristina Ţenea2,
  • Daniela Tălăpan2,
  • Dragoş Florea1, 2 and
  • Alexandru Rafila1, 2
BMC Infectious Diseases201414(Suppl 7):O24

https://doi.org/10.1186/1471-2334-14-S7-O24

Published: 15 October 2014

Background

Since 2011 Clostridium difficile infection (CDI) has been an emerging nosocomial problem in Romanian hospitals, due to its growing incidence and severity. Objectives: To describe risk factors and clinical outcome for CDI cases, and strains characterization.

Methods

We collected data for all 398 confirmed or probable cases of CDI admitted during 15 November 2013-28 February 2014 in 11 hospitals: 5 from Bucharest, and 7 from Cluj, Iaşi, Timişoara, Târgu Mureş and Braşov. PCR ribotyping was performed at Cantacuzino Institute and E-test (for moxifloxacin and metronidazole) and binary toxin gene identification (PCR) were performed at Matei Balş Institute. The hospitals sent a maximum 20 feces samples for each test.

Results

Mean age was 63.4 years (range 1-94 years), and sex ratio F:M=1.08:1. For 40 patients, CDI were community-acquired, 12.5% CI95% (9.3%-16.6%), if indeterminate origin cases were excluded; 12 of 13 strains tested from these patients were ribotype 027 and/or binary toxin positive. A post-antibiotic CDI were documented in 346/385 analyzable cases, 89.9% CI95% (86.5%-92.5%); 53.6% of them received medication from at least two different antibiotic groups. The most utilized antibiotics were cephalosporins and quinolones. In 13.1% cases with known history, the CDI episode was a recurrent one CI95% (10.1%-17%); binary toxin was retrieved in all six tested strains from recurrent CDI. A number of 45 episodes were considered severe CDI (25 deaths, 7 intensive care required, 6 colectomies, 7 patients discharged with worsened condition), 12.1% from 371 episodes with identified outcome CI95% (9.2%-15.8%). From 155 tested strains, 122 belonged to 027 ribotype and/or were binary toxin positive, 78.7% CI95% (71.6%-84.4%); the remaining 33 strains belonged to ribotypes 002 (n=4), 014 (n=2), 018 (n=2), 087 (n=2), one isolate each 001, 011, 012, 017, 020, 106 ribotypes and 17 strains were binary toxin negatives. The 027 ribotype and/or binary toxin presence were prevalent in all hospitals, ranging from 69.7% to 100%. In 62 of 84 tested isolates, the MIC for moxifloxacin was greater than 2 mg/L, the epidemiological cut-off value, more frequent in ribotype 027 or binary toxin positive strains, RR=2.02 (1.27; 3.22), p<0.0001.

Conclusion

The severe CDI episodes were relatively frequent in our study. The main risk factor for CDI was the previous antibiotic treatment, especially with cephalosporins and quinolones. The wide circulation of 027 ribotype could explain the persistence of hospital outbreaks of CDI and the increase of community-acquired CDI episodes. No discrepancies were noticed among participant hospitals.

Authors’ Affiliations

(1)
Carol Davila University of Medicine and Pharmacy
(2)
National Institute for Infectious Diseases "Prof. Dr. Matei Balş"
(3)
National Institute of Public Health
(4)
Cantacuzino National Institute for Research and Development for Microbiology and Immunology

Copyright

© Popescu et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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