Clostridioides (Clostridium) difficile infections in a geriatric hospital in Costa Rica

Authors

DOI:

https://doi.org/10.51481/amc.v64i3.1158

Keywords:

Clostridioides difficile, epidemiología, hospitales geriátricos, diarrea, Costa Rica

Abstract

Aim: To describe the characteristics of elder patients diagnosed with Clostridioides (Clostridium) difficile infection in a geriatric hospital in Costa Rica.

Methods: A retrospective observational study was done with demographic and clinical information from 141 patients admitted in the National Geriatric and Gerontology Hospital of Costa Rica from 2015 to 2018, who presented a positive immunochromatographic test for the detection of C. difficile antigen and/or toxins in diarrheic feces. Continuous variableswere compared through one-way ANOVA test, while categorical variables were compared using Fisher's exact test. The risk factors for each of the groups were evaluated by univariate
analysis. P values < 0.05 were considered statistically significant with 95% confidence.

Results: We studied 141 patients with diarrhea associated with C. difficile, the average age of the patients was 83 years and 75% were women. 35% of the cases were community acquired and 27% were severe cases. Antimicrobial consumption was given mainly by cephalosporins and fluoroquinolones. Metronidazol was the most used treatment (81%)
and the C. difficile associated mortality 30 days post infection was 35%.
Conclusion: This is the first epidemiological report of C. difficile infection in elderly hospitalized population. Also, it evidences an important percentage of community acquired and severe cases, calling for the establishment of local treatment and prevention guidelines for this infection.

Downloads

Download data is not yet available.

References

McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018; 66: e1-48. DOI: 10.1093/cid/cix1085.

Hernández-Rocha C, Tejos Sufan R, Plaza-Garrido Á, Barra-Carrasco J, Agüero Luengo C, Inostroza Levy G, et al. Rendimiento de índices pronósticos en infección asociada a Clostridium difficile grave: análisis retrospectivo en un hospital universitario. Rev Chil Infectol. 2014; 31: 659-665. DOI: 10.4067/S0716-10182014000600003.

O'Connor JR, Johnson S, Gerding DN. Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain. Gastroenterology. 2009; 136: 1913-1924. DOI: 10.1053/j.gastro.2009.02.073.

Leffler DA, Lamont JT. Clostridium difficile Infection. N Eng J Med. 2015; 372: 1539-1548. DOI: 10.1056/NEJMra1403772.

Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005; 366: 1079-1084. DOI: 10.1016/S0140-6736(05)67420-X.

Quesada-Gómez C, López-Ureña D, Acuña-Amador L, Villalobos-Zúñiga M, Du T, Freire R, et al. Emergence of an outbreak-associated Clostridium difficile variant with increased virulence. J Clin Microbiol. 2015; 53: 1216-1226. DOI: 10.1128/JCM.03058-14.

Villalobos-Zúñiga MA, Boza-Cordero R. Caracterización epidemiológica, clínica y microbiológica del brote de diarrea asociado a Clostridium difficile, ocurrido en el Hospital San Juan de Dios, 2008-2009. Acta méd. costarric. 2012; 54: 152-158.

Eze P, Balsells E, Kyaw MH, Nair H. Risk factors for Clostridium difficile infections - an overview of the evidence base and challenges in data synthesis. J Glob Health. 2017; 7: 1-9. DOI: 10.7189/jogh.07.010417.

Asempa TE, Nicolau DP. Clostridium difficile infection in the elderly: an update on management. Clin Interv Aging. 2017; 12: 1799-1809. DOI: 10.2147/CIA.S149089.

Chopra T, Awali RA, Biedron C, Vallin E, Bheemreddy S, Saddler CM, et al. Predictors of Clostridium difficile infection-related mortality among older adults. Am J Infect Control. 2016; 44: 1219-1223. DOI: 10.1016/j.ajic.2016.04.231.

Zurita DO, Lozano IG. Estudio de concordancia y grado de acuerdo entre dos pruebas diagnósticas de infección por Clostridium difficile. An Med Asoc Med Hosp ABC. 2018; 63: 100-104.

Crobach MJT, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016; 22: S63-81. DOI: 10.1016/j.cmi.2016.03.010.

Donskey CJ. Clostridium difficile in older adults. Infect Dis Clin North Am. 2017; 31: 743-756. DOI: 10.1016/j.idc.2017.07.003.

Ofori E, Ramai D, Dhawan M, Mustafa F, Gasperino J, Reddy M. Community-acquired Clostridium difficile: epidemiology, ribotype, risk factors, hospital and intensive care unit outcomes, and current and emerging therapies. J Hosp Infect. 2018; 99: 436-442. DOI: 10.1016/j.jhin.2018.01.015.

Karas JA, Bradshaw S, Mahmud W, Enoch DA. Mortality in hospitalized older adults associated with Clostridium difficile infection at a district hospital. Infect Dis Rep. 2010; 2: e8. DOI: 10.4081/idr.2010.1824.

Owens RC, Donskey CJ, Gaynes RP, Loo VG, Muto CA. Antimicrobial-Associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008; 46: S19-31. DOI: 10.1086/521859.

Teng C, Reveles KR, Obodozie-Ofoegbu OO. Clostridium difficile infection risk with important antibiotic classes: an analysis of the FDA adverse event reporting system. Int J Med Sci. 2019; 16: 630-635. DOI: 10.7150/ijms.30739.

Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010; 31: 431-455. DOI: 10.1086/651706.

Debast SB, Bauer MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2014; 20: 1-26. DOI: 10.1111/1469-0691.12418.

Vardakas KZ, Polyzos KA, Patouni K, Rafailidis PI, Samonis G, Falagas ME. Treatment failure and recurrence of Clostridium difficile infection following treatment with vancomycin or metronidazole: a systematic review of the evidence. Int J Antimicrob Agents. 2012; 40: 1-8. DOI: 10.1016/j.ijantimicag.2012.01.004.

Zar FA, Bakkanagari SR, Moorthi KMLST, Davis MB. A Comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007; 45: 302-307. DOI: 10.1086/519265.

Published

2022-11-01

How to Cite

Clostridioides (Clostridium) difficile infections in a geriatric hospital in Costa Rica. (2022). Acta Médica Costarricense , 64(3), 1-9. https://doi.org/10.51481/amc.v64i3.1158