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Open Access Highly Accessed Research article

Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011

Stefano Di Bella1, Maria Musso1, Maria A Cataldo1, Marcello Meledandri2, Eugenio Bordi1, Daniela Capozzi3, Maria C Cava4, Patrizia Chiaradonna5, Grazia Prignano6 and Nicola Petrosillo1*

Author Affiliations

1 National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense 292, Rome, 00149, Italy

2 S. Filippo Neri Hospital, Via Martinotti 20, Rome, 00135, Italy

3 G.B. Grassi Hospital, Via Passeroni 28, Ostia Lido, Rome, 00122, Italy

4 Sandro Pertini Hospital, Via Monti Tiburtini 385, Rome, 00157, Italy

5 San Camillo-Forlanini Hospital, Circ, Gianicolense 87, Rome, 00152, Italy

6 San Gallicano Dermatologic Institute, IRCCS IFO, Via Elio Chianesi 53, Rome, 00144, Italy

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BMC Infectious Diseases 2013, 13:146  doi:10.1186/1471-2334-13-146

Published: 22 March 2013

Abstract

Background

In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found.

We have conducted a 6-year retrospective study to evaluate the incidence of CDI in Italian urban hospitals.

Methods

Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded.

Results

A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%).

Conclusions

A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable.

Keywords:
Clostridium difficile; Epidemiology; Incidence; Italy; Hospitals; Europe