Point-prevalence survey of healthcare facility-onset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study.

• Main Authors: Athanasios Skoutelis, Angelos Pefanis, Sotirios Tsiodras, Nikolaos V Sipsas, Moyssis Lelekis, Marios C Lazanas, Panagiotis Gargalianos, George N Dalekos, Emmanuel Roilides, George Samonis, Efstratios Maltezos, Dimitrios Hatzigeorgiou, Malvina Lada, Symeon Metallidis, Athena Stoupis, Georgios Chrysos, Lazaros Karnesis, Styliani Symbardi, Chariclia V Loupa, Helen Giamarellou, Ioannis Kioumis, Helen Sambatakou, Epameinondas Tsianos, Maria Kotsopoulou, Areti Georgopali, Klairi Liakou, Stavroula Perlorentzou, Stamatina Levidiotou, Marina Giotsa-Toutouza, Helen Tsorlini-Christoforidou, Ilias Karaiskos, Georgia Kouppari, Eleftheria Trikka-Graphakos, Maria-Anna Ntrivala, Kate Themeli-Digalaki, Anastasia Pangalis, Melina Kachrimanidou, Maria Martsoukou, Stergios Karapsias, Maria Panopoulou, Sofia Maraki, Anagnostina Orfanou, Efthymia Petinaki, Maria Orfanidou, Vasiliki Baka, Antonios Stylianakis, Iris Spiliopoulou, Stavroula Smilakou, Loukia Zerva, Evangelos Vogiatzakis, Eleni Belesiotou, Charalambos A Gogos
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2017-01-01
• Series: PLoS ONE
• Online Access: http://europepmc.org/articles/PMC5559069?pdf=render

The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013.There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea.5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009).The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6.