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European Journal of Clinical Microbiology & Infectious Diseases

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01-11-2018 | Original Article

Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital

Authors: Nagham Khanafer, Philippe Vanhems, Frédéric Barbut, Catherine Eckert, Michel Perraud, François Vandenesch, Christine Luxemburger, Clarisse Demont, CDI01 Study Group

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 11/2018

Abstract

Clostridium difficile infection (CDI) produces a variety of clinical presentations ranging from mild diarrhea to severe infection with fulminant colitis, septic shock, and death. CDI puts a heavy burden on healthcare systems due to increased morbidity and mortality, and higher costs. We evaluated the clinical impact of CDI in terms of complications and mortality in a French university hospital compared with patients with diarrhea unrelated to CDI. A 3-year prospective, observational, cohort study was conducted in a French university hospital. Inpatients aged 18 years or older with CDI-suspected diarrhea were eligible to participate in the study and were followed for up to 60 days after CDI testing. Among the 945 patients with diarrhea included, 233 had confirmed CDI. Overall, 106 patients (11.2%) developed at least one of the following complications: colectomy, colitis, ileitis/rectitis, ileus, intestinal perforation, megacolon, multiorgan failure, pancolitis, peritonitis, pseudomembranous colitis, renal failure, and sepsis/septic shock. The complication rate was significantly higher in patients with diarrhea related to C. difficile than in non-CDI patients (26.6% vs 6.2%, P < 0.001). At day 60, 137 (14.5%) patients had died, with 37 deaths among the CDI group (15.9%). Death was attributable to CDI in 15 patients (6.4%). Complications are more frequent among CDI cases than in patients with diarrhea not related to C. difficile. Assessment of CDI is necessary to ensure allocation of sufficient resources to CDI prevention.

Martin M, Zingg W, Knoll E, Wilson C, Dettenkofer M, Group PS (2014) National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review. J Hosp Infect 87(4):212–219. https://doi.org/10.1016/j.jhin.2014.05.002 CrossRefPubMed

Feuerstadt P, Das R, Brandt LJ (2014) The evolution of Urban C. difficile infection (CDI): CDI in 2009–2011 is less severe and has better outcomes than CDI in 2006–2008. Am J Gastroenterol 109:1265–1276CrossRefPubMed

Kim J, Kang JO, Kim H, Seo MR, Choi TY, Pai H, Kuijper EJ, Sanders I, Fawley W (2013) Epidemiology of Clostridium difficile infections in a tertiary-care hospital in Korea. Clin Microbiol Infect 19(6):521–527CrossRefPubMed

Muto CA, Blank MK, Marsh JW, Vergis EN, O’Leary MM, Shutt KA, Pasculle AW, Pokrywka M, Garcia JG, Posey K, Roberts TL, Potoski BA, Blank GE, Simmons RL, Veldkamp P, Harrison LH, Paterson DL (2007) Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis 45(10):1266–1273. https://doi.org/10.1086/522654 CrossRefPubMed

Lo Vecchio A, Zacur GM (2011) Clostridium difficile infection: an update on epidemiology, risk factors, and therapeutic options. Curr Opin Gastroenterol 28(1):1–9CrossRef

Bishara J, Peled N, Pitlik S, Samra Z (2008) Mortality of patients with antibiotic-associated diarrhoea: the impact of Clostridium difficile. J Hosp Infect 68(4):308–314. https://doi.org/10.1016/j.jhin.2008.01.033 CrossRefPubMed

Eckert C, Coignard B, Hebert M, Tarnaud C, Tessier C, Lemire A, Burghoffer B, Noel D, Barbut F, Group IC-RW (2013) Clinical and microbiological features of Clostridium difficile infections in France: the ICD-RAISIN 2009 national survey. Med Mal Infect 43(2):67–74. https://doi.org/10.1016/j.medmal.2013.01.004 CrossRefPubMed

Khanafer N, Oltra L, Hulin M, Dauwalder O, Vandenesch F, Vanhems P (2016) Clostridium difficile infection in a French university hospital: eight years of prospective surveillance study. Medicine 95(23):e3874. https://doi.org/10.1097/MD.0000000000003874 CrossRefPubMedPubMedCentral

Bidet P, Lalande V, Salauze B, Burghoffer B, Avesani V, Delmee M, Rossier A, Barbut F, Petit JC (2000) Comparison of PCR-ribotyping, arbitrarily primed PCR, and pulsed-field gel electrophoresis for typing Clostridium difficile. J Clin Microbiol 38(7):2484–2487PubMedPubMedCentral

10.

Muto CA, Pokrywka M, Shutt K, Mendelsohn AB, Nouri K, Posey K, Roberts T, Croyle K, Krystofiak S, Patel-Brown S, Pasculle AW, Paterson DL, Saul M, Harrison LH (2005) A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 26(3):273–280. https://doi.org/10.1086/502539 CrossRefPubMed

11.

Pepin J, Valiquette L, Cossette B (2005) Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ 173(9):1037–1042. https://doi.org/10.1503/cmaj.050978 CrossRefPubMedPubMedCentral

12.

Barbut F, Jones G, Eckert C (2011) Epidemiology and control of Clostridium difficile infections in healthcare settings: an update. Curr Opin Infect Dis 24(4):370–376. https://doi.org/10.1097/QCO.0b013e32834748e5 CrossRefPubMed

13.

Rodriguez-Pardo D, Almirante B, Bartolome RM, Pomar V, Mirelis B, Navarro F, Soriano A, Sorli L, Martinez-Montauti J, Molins MT, Lung M, Vila J, Pahissa A (2013) Epidemiology of Clostridium difficile infection and risk factors for unfavorable clinical outcomes: results of a hospital-based study in Barcelona, Spain. J Clin Microbiol 51(5):1465–1473CrossRefPubMedPubMedCentral

14.

Mascart G, Delmee M, Van Broeck J, Cytryn E, Karmali R, Cherifi S (2013) Impact of ribotype 027 on Clostridium difficile infection in a geriatric department. Eur J Clin Microbiol Infect Dis:1435–4373

15.

Bartlett JG (2006) Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med 145(10):758–764CrossRefPubMed

16.

Gould CV, Edwards JR, Cohen J, Bamberg WM, Clark LA, Farley MM, Johnston H, Nadle J, Winston L, Gerding DN, McDonald LC, Lessa FC, Clostridium difficile Infection Surveillance Investigators, Centers for Disease Control and Prevention (2013) Effect of nucleic acid amplification testing on population-based incidence rates of Clostridium difficile infection. Clin Infect Dis 57 (9):1304–1307. https://doi.org/10.1093/cid/cit492 CrossRefPubMed

17.

Abou Chakra CN, McGeer A, Labbe AC, Simor AE, Gold WL, Muller MP, Powis J, Katz K, Garneau JR, Fortier LC, Pepin J, Cadarette SM, Valiquette L (2015) Factors associated with complications of Clostridium difficile infection in a multicenter prospective cohort. Clin Infect Dis 61(12):1781–1788. https://doi.org/10.1093/cid/civ749 CrossRefPubMedPubMedCentral

18.

Henrich TJ, Krakower D, Bitton A, Yokoe DS (2009) Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis 15(3):415–422. https://doi.org/10.3201/eid1503.080312 CrossRefPubMedPubMedCentral

19.

Morrison RH, Hall NS, Said M, Rice T, Groff H, Brodine SK, Slymen D, Lederman ER (2011) Risk factors associated with complications and mortality in patients with Clostridium difficile infection. Clin Infect Dis 53(12):1173–1178. https://doi.org/10.1093/cid/cir668 CrossRefPubMed

20.

Tan ET, Robertson CA, Brynildsen S, Bresnitz E, Tan C, McDonald C (2007) Clostridium difficile-associated disease in New Jersey hospitals, 2000–2004. Emerg Infect Dis 13(3):498–500. https://doi.org/10.3201/eid1303.060294 CrossRefPubMedPubMedCentral

21.

Evans CT, Safdar N (2015) Current trends in the epidemiology and outcomes of Clostridium difficile infection. Clin Infect Dis 60(Suppl 2):S66–S71. https://doi.org/10.1093/cid/civ140 CrossRefPubMed

22.

Wiegand PN, Nathwani D, Wilcox MH, Stephens J, Shelbaya A, Haider S (2012) Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection. J Hosp Infect 81(1):1–14. https://doi.org/10.1016/j.jhin.2012.02.004 CrossRefPubMed

23.

Hall JF, Berger D (2008) Outcome of colectomy for Clostridium difficile colitis: a plea for early surgical management. Am J Surg 196(3):384–388. https://doi.org/10.1016/j.amjsurg.2007.11.017 CrossRefPubMed

24.

Kasper AM, Nyazee HA, Yokoe DS, Mayer J, Mangino JE, Khan YM, Hota B, Fraser VJ, Dubberke ER, Centers for Disease C, Prevention Epicenters P (2012) A multicenter study of Clostridium difficile infection-related colectomy, 2000–2006. Infect Control Hosp Epidemiol 33(5):470–476. https://doi.org/10.1086/665318 CrossRefPubMedPubMedCentral

25.

Barbut F, Gariazzo B, Bonne L, Lalande V, Burghoffer B, Luiuz R, Petit JC (2007) Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: results of a retrospective study, 2000–2004. Infect Control Hosp Epidemiol 28(2):131–139. https://doi.org/10.1086/511794 CrossRefPubMed

26.

Fenner L, Frei R, Gregory M, Dangel M, Stranden A, Widmer AF (2008) Epidemiology of Clostridium difficile-associated disease at University Hospital Basel including molecular characterisation of the isolates 2006–2007. Eur J Clin Microbiol Infect Dis 27(12):1201–1207. https://doi.org/10.1007/s10096-008-0564-9 CrossRefPubMed

27.

Pepin J, Alary ME, Valiquette L, Raiche E, Ruel J, Fulop K, Godin D, Bourassa C (2005) Increasing risk of relapse after treatment of Clostridium difficile colitis in Quebec, Canada. Clin Infect Dis 40(11):1591–1597. https://doi.org/10.1086/430315 CrossRefPubMed

28.

Sim JH, Truong C, Minot SS, Greenfield N, Budvytiene I, Lohith A, Anikst V, Pourmand N, Banaei N (2017) Determining the cause of recurrent Clostridium difficile infection using whole genome sequencing. Diagn Microbiol Infect Dis 87(1):11–16. https://doi.org/10.1016/j.diagmicrobio.2016.09.023 CrossRefPubMed

29.

Pepin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, Pepin K, Chouinard D (2004) Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 171(5):466–472. https://doi.org/10.1503/cmaj.1041104 CrossRefPubMedPubMedCentral

30.

Zilberberg MD, Shorr AF, Kollef MH (2008) Increase in adult Clostridium difficile-related hospitalizations and case-fatality rate, United States, 2000–2005. Emerg Infect Dis 14(6):929–931. https://doi.org/10.3201/eid1406.071447 CrossRefPubMedPubMedCentral

31.

Salazar M, Baskin L, Garey KW, DuPont HL (2009) Clostridium difficile-related death rates in Texas 1999–2005. J Inf Secur 59(5):303–307. https://doi.org/10.1016/j.jinf.2009.08.019 CrossRef

32.

Hensgens MP, Goorhuis A, van Kinschot CM, Crobach MJ, Harmanus C, Kuijper EJ (2011) Clostridium difficile infection in an endemic setting in the Netherlands. Eur J Clin Microbiol Infect Dis 30(4):587–593. https://doi.org/10.1007/s10096-010-1127-4 CrossRefPubMed

33.

Abou Chakra CN, Pepin J, Sirard S, Valiquette L (2014) Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLoS One 9(6):e98400. https://doi.org/10.1371/journal.pone.0098400 CrossRefPubMedPubMedCentral

34.

Laza R, Jurac R, Crisan A, Lazureanu V, Licker M, Popovici ED, Baditoiu LM (2015) Clostridium difficile in western Romania: unfavourable outcome predictors in a hospital for infectious diseases. BMC Infect Dis 15:141. https://doi.org/10.1186/s12879-015-0895-y CrossRefPubMedPubMedCentral

35.

Karas JA, Enoch DA, Aliyu SH (2010) A review of mortality due to Clostridium difficile infection. J Infect 61(1):1–8. https://doi.org/10.1016/j.jinf.2010.03.025 CrossRefPubMed

36.

Davies KA, Ashwin H, Longshaw CM, Burns DA, Davis GL, Wilcox MH; EUCLID study group (2016) Diversity of Clostridium difficile PCR ribotypes in Europe: results from the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID), 2012 and 2013. Euro Surveill: 21 (29)

37.

Wilcox MH, Shetty N, Fawley WN, Shemko M, Coen P, Birtles A, Cairns M, Curran MD, Dodgson KJ, Green SM, Hardy KJ, Hawkey PM, Magee JG, Sails AD, Wren MW (2012) Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis 55(8):1056–1063. https://doi.org/10.1093/cid/cis614 CrossRefPubMed

38.

Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC (2005) Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 9491:1079–1084. https://doi.org/10.1016/S0140-6736(05)67420-X CrossRef

39.

Walk ST, Micic D, Jain R, Lo ES, Trivedi I, Liu EW, Almassalha LM, Ewing SA, Ring C, Galecki AT, Rogers MA, Washer L, Newton DW, Malani PN, Young VB, Aronoff DM (2012) Clostridium difficile ribotype does not predict severe infection. Clin Infect Dis 55(12):1661–1668. https://doi.org/10.1093/cid/cis786 CrossRefPubMedPubMedCentral

Title: Outcomes of Clostridium difficile-suspected diarrhea in a French university hospital
Authors: Nagham Khanafer
Philippe Vanhems
Frédéric Barbut
Catherine Eckert
Michel Perraud
François Vandenesch
Christine Luxemburger
Clarisse Demont
CDI01 Study Group
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 11/2018
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-018-3348-x

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