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Abstract
Background/Aims
Clostridium difficile is the predominant cause of nosocomial diarrhea. Recently, the incidence of Clostridium difficile infection (CDI) increases in Europe and North America. A retrospective study was performed to evaluate the change of incidence and clinical features of CDI in Korea.
Methods
From January 2003 to December 2008, inpatients diagnosed with CDI in Seoul Paik hospital were enrolled. The diagnosis of CDI was made when patients complained diarrhea with any positive results in C. difficile toxin assay, stool culture, or endoscopy. The incidence, recurrence rate, and clinical features were compared between early period (2003-2005) and late period (2006-2008).
Results
The incidence of CDI was 21.73 cases per 10,000 admitted patients in early period group, and significantly increased to 71.71 cases per 10,000 admitted patients in late period group (p <0.01). The hospital stay duration at the time of CDI diagnosis was shorter in late period group. Cephalosporin had the highest ratio as the causative antibiotics of CDI. However, there was no difference in recurrence rate between early and late period groups. Recurrence associated clinical factor was serum albumin level.
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Fig. 1.
The incidence rate of CDI according to department. (A) The department of neurosurgery had the highest incidence rates of CDI. (B) Among the entire CDI patients, internal medicine and neurosurgery occu-pied higher portion than other departments.
CDI, C. difficile infection; NS, neurosurgery; IM, internal medi-cine; GS, general surgery; OS, orthopedic surgery.
Fig. 2.
The incidence rate of CDI. It showed increasing tendency in adult hospitalized patients during recent 6 years.
CDI, C. difficile infection.
Fig. 3.
The ratio of PMC/CDI according to groups. The ratio of PMC/CDI in early group was significantly higher than late group (∗p<0.01).
PMC, pseudomembranous colitis; CDI, C. difficile infection.
Fig. 4.
Antibiotics presumed to be a cause of CDI. Cephalosporin had the highest ratio among causative antibiotics of CDI.
CDI, C. difficile infection.
Fig. 5.
Recurrence rate of CDI. There was no difference in recurrence rate of CDI between both groups (p=0.82).
CDI, C. difficile infection.
Table 1.
Characteristics of Patients with C. difficile Infection
| Early period group | Late period group | p-value | |
|---|---|---|---|
| CDI/total patients | 69/31,757 | 233/32,492 | 2 <0.01∗ |
| Age (years) | 67.0±15.7 | 63.2±16.0 | 0.08 |
| Gender (M:F) | 35:34 | 117:116 | 0.94 |
| Prior hospital stay (days) | 65.8±84.6 | 36.5±46.1 | <0.01∗ |
| Duration of diarrhea (days) | 9.4±8.0 | 7.9±4.8 | 0.14 |
| Frequency of diarrhea (/day) | 5.2±2.1 | 5.3±2.4 | 0.75 |
| Number of antibiotics | 1.5±0.7 | 1.6±1.1 | 0.18 |
| Serum albumin (g/dL) | 3.1±0.7 | 3.2±0.6 | 0.20 |
Table 2.
Diagnostic Methods of C. difficile Infection
Table 3.
Endoscopic Findings of C. difficile Infection
| Normal | Non-specific colitis | PMC | Total | |
|---|---|---|---|---|
| Early period group | 1 | 1 | 31 | 33 |
| Late period group | 10 | 10 | 45 | 65 |
Table 4.
Factors That Related to Recurrence of C. difficile Infection
| Recurred group (n=37) | Non-recurred group (n=265) | d p-value | |
|---|---|---|---|
| Age (years) | 67.0±16.6 | 63.6±15.9 | 0.24 |
| Gender | M (21) | M (131) | 0.40 |
| Prior hospital stay (days) | 47.7±50.8 | 42.6±59.4 | 0.62 |
| Frequency of diarrhea (/day | y) 5.1±2.7 | 5.3±2.3 | 0.58 |
| Number of antibiotics | 1.7±0.8 | 1.6±1.0 | 0.53 |
| Serum albumin (g/dL) | 3.0±0.5 | 3.2±0.6 | <0.01∗ |
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