Community-Onset Clostridioides Difficile Infection in Hospitalized Patients in The Netherlands
| Autor: | Daan W. Notermans, Celine Harmanus, Ingrid M J G Sanders, S C De Greeff, Ed J. Kuijper, Monique J. T. Crobach |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Clostridium difficile infections in humans genetic structures Hospitalized patients business.industry Clostridioides difficile 030106 microbiology Reference laboratory Clostridium difficile 03 medical and health sciences 0302 clinical medicine Infectious Diseases Oncology Median time Internal medicine medicine Major Article surveillance In patient 030212 general & internal medicine Nursing homes business Clostridioides Community onset |
| Zdroj: | Open Forum Infectious Diseases Open Forum Infectious Diseases, 6(12). OXFORD UNIV PRESS INC |
| Popis: | Background Clostridioides difficile infection (CDI) is increasingly reported in the community. The aim of this study was to analyze characteristics of hospitalized patients with community-onset CDI (CO-CDI). Methods In the Netherlands, 24 hospitals (university-affiliated and general hospitals) participate in the sentinel CDI surveillance program. Clinical characteristics and 30-day outcomes of hospitalized patients >2 years old diagnosed with CDI are registered. Samples of these patients are sent to the national reference laboratory for polymerase chain reaction ribotyping. Data obtained for this surveillance from May 2012 to May 2018 were used to compare CO-CDI with hospital-onset (HO)-CDI episodes. Results Of 5405 registered cases, 2834 (52.4%) were reported as HO-CDI, 2174 (40.2%) were CO-CDI, and 339 (6.3%) had onset of symptoms in another healthcare facility (eg, nursing home). The proportion of CO-CDI increased over the years and was lower during winter months. Hospitalized patients with CO-CDI were younger (63.8 vs 68.0 years, P < .001) and more often females (53.0% vs 49.6%, P = .02) than patients with HO-CDI. Median time between onset of symptoms and CDI testing was longer in CO-CDI (4 vs 1 day, P < .001). Similar ribotypes were found in CO-CDI and HO-CDI, but ribotype 001 was more frequent among HO-CDI, whereas ribotype 023 was more frequent in CO-CDI. Six of 7 (85.7%) surgeries due to CDI, 27 of 50 (54%) ICU admissions due to CDI, and 48 of 107 (44.9%) of CDI-associated deaths were attributable to CO-CDI. Conclusions Our study demonstrates that patients hospitalized with CO-CDI contribute substantially to the total number of CDI episodes and CDI-associated complications in hospitals, stressing the need for awareness and early testing for CDI in community and outpatient settings and also in patients admitted from community with diarrhoea. Surveillance programs that also target nonhospitalized CDI patients are needed to understand the true burden and dynamics of CDI. Approximately 40% of hospitalized patients with Clostridioides difficile infection (CDI) have community-onset of symptoms. Community-onset CDI contributes substantially to CDI-associated complications during hospital admission. |
| Databáze: | OpenAIRE |
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