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

被引：10

作者：

Skoutelis, Athanasios ^{[1
]}

Pefanis, Angelos ^{[2
]}

Tsiodras, Sotirios ^{[3
]}

Sipsas, Nikolaos V. ^{[4
,5
]}

Lelekis, Moyssis ^{[6
]}

Lazanas, Marios C. ^{[7
]}

Gargalianos, Panagiotis ^{[8
]}

Dalekos, George N. ^{[9
]}

Roilides, Emmanuel ^{[10
]}

Samonis, George ^{[11
]}

Maltezos, Efstratios ^{[12
]}

Hatzigeorgiou, Dimitrios ^{[13
]}

Lada, Malvina ^{[14
]}

Metallidis, Symeon ^{[15
]}

Stoupis, Athena ^{[16
]}

Chrysos, Georgios ^{[17
]}

Karnesis, Lazaros ^{[18
]}

Symbardi, Styliani ^{[19
]}

Loupa, Chariclia V. ^{[20
]}

Giamarellou, Helen

Kioumis, Ioannis ^{[22
]}

Sambatakou, Helen ^{[21
,23
]}

Tsianos, Epameinondas ^{[24
]}

Kotsopoulou, Maria ^{[25
]}

Georgopali, Areti ^{[26
]}

Liakou, Klairi ^{[26
]}

Perlorentzou, Stavroula ^{[25
]}

Levidiotou, Stamatina ^{[24
]}

Giotsa-Toutouza, Marina ^{[27
]}

Tsorlini-Christoforidou, Helen ^{[28
]}

Karaiskos, Ilias ^{[21
]}

Kouppari, Georgia ^{[20
]}

Trikka-Graphakos, Eleftheria ^{[19
]}

Ntrivala, Maria-Anna ^{[18
]}

Themeli-Digalaki, Kate ^{[17
]}

Pangalis, Anastasia ^{[16
]}

Kachrimanidou, Melina ^{[15
]}

Martsoukou, Maria ^{[14
]}

Karapsias, Stergios ^{[13
]}

Panopoulou, Maria

Maraki, Sofia ^{[29
]}

Orfanou, Anagnostina ^{[30
]}

Petinaki, Efthymia ^{[9
]}

Orfanidou, Maria ^{[8
,12
]}

Baka, Vasiliki ^{[7
]}

Stylianakis, Antonios ^{[6
]}

Spiliopoulou, Iris ^{[31
]}

Smilakou, Stavroula ^{[32
]}

Zerva, Loukia ^{[3
]}

Belesiotou, Eleni ^{[1
]}

机构：

[1] Gen Hosp Athens Evangelismos, Athens, Greece

[2] Sotiria Gen & Chest Dis Hosp Athens, Athens, Greece

[3] Univ Athens, Attikon Univ Hosp, Med Sch, Athens, Greece

[4] Univ Athens, Laiko Gen Hosp, Athens, Greece

[5] Univ Athens, Med Sch, Athens, Greece

[6] Gen Hosp Attika KAT, Athens, Greece

[7] Gen Hosp Athens Korgialenio Benakio Red Cross, Athens, Greece

[8] Gen Hosp Athens G Gennimatas, Athens, Greece

[9] Univ Thessaly, Univ Gen Hosp Larissa, Med Sch, Larisa, Greece

[10] Aristotle Univ Thessaloniki, Hippokrat Gen Hosp Thessaloniki, Thessaloniki, Greece

[11] Univ Crete, Univ Hosp Herakl, Sch Med, Iraklion, Crete, Greece

[12] Democritus Univ Thrace, Univ Gen Hosp Evros, Alexandroupolis, Greece

[13] 251 Air Force Gen Hosp, Athens, Greece

[14] Sismanogl Gen Hosp Athens, Athens, Greece

[15] Aristotle Univ Thessaloniki, AHEPA Univ Hosp Thessaloniki, Med Sch, Thessaloniki, Greece

[16] Athens Med Ctr, Athens, Greece

[17] Tzaneio Gen Hosp, Piraeus, Greece

[18] 401 Mil Hosp Athens, Athens, Greece

[19] Thriasio Gen Hosp Elefsis, Attica, Greece

[20] A Fleming Gen Hosp Athens, Athens, Greece

[21] HYGEIA Hosp, Athens, Greece

[22] Aristotle Univ Thessaloniki, Gen Hosp G Papanikolaou, Thessaloniki, Greece

[23] Univ Athens, Hippokrat Gen Hosp, Athens, Greece

[24] Univ Ioannina, Univ Gen Hosp Ioannina, Ioannina, Greece

[25] Metaxa Canc Hosp, Piraeus, Greece

[26] Astellas Pharmaceut, Attica, Greece

[27] Hippokrat Gen Hosp Athens, Athens, Greece

[28] Gen Hosp G Papanikolaou, Thessaloniki, Greece

[29] Univ Hosp Herakl, Iraklion, Crete, Greece

[30] Hippokrat Gen Hosp Thessaloniki, Thessaloniki, Greece

[31] Univ Patras, Univ Gen Hosp Patras, Med Sch, Patras, Greece

[32] Laikon Gen Hosp, Athens, Greece

来源：

PLOS ONE | 2017年 / 12卷 / 08期

关键词：

RISK-FACTORS; EPIDEMIOLOGY; OUTCOMES; DISEASE; ANTIBIOTICS; MORTALITY; DIARRHEA; EUROPE;

D O I：

10.1371/journal.pone.0182799

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background 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. Methods 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. Results 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). Conclusions 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.

引用

页数：14

共 30 条

[1] The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? [J].