外科ジャーナル

Clostridium Difficile Infection - An Optimistic View

Abstract

Tudor Frunză, Alexandru Rotundu, Ștefan Morărașu, Sorinel Luncă and Gabriel Dimofte

Background: Clostridium difficile infection (CDI) is one of the most common infectious complications affecting vulnerable patients, i.e., after surgery or immunosuppressive therapies, posing a significant risk in an oncological unit.

Materials and methods: We analyzed data recovered from 164 cases of CDI during the period of 2014-2016 in the Regional Oncologic Institute Iasi, majority admitted in the surgical and hematological units. In all cases diagnostic was confirmed if stool samples tested positive for GDH and at least one of the toxins A or B.

Results: The study shows a large population of elder patients (median age 64 years) with female dominance (54%). Out of 117 surgical cases 64% had surgical procedures on the gastro-intestinal tract. Although 20% of patients had equivocal symptoms from admission, the average interval (from admission) until first symptoms developed was 7 days. The confirmation of the diagnosis came in the next day/24h in 68% of cases, leading to initiation of efficient therapy. Although CDI is regarded as an antibiotic associated disease, our data revealed that only one third of patients received antibiotic treatment in the last 3 months. Among the risk factors that may have an influence over development of CDI, antisecretory therapy was delivered to 37% of cases. Epidemiology reports showed that less than 8% of patients had previous contact with other CDI confirmed case. Overall mortality was 4.87% and CDI related mortality was 0.85%.

Conclusions: Even though CDI still poses a great threat during prolonged hospitalization and is especially dangerous in oncologic patients, the early recognition of disease onset and the easy access to diagnostic tests triggers an immediate course of treatment and decreases complication and the risk of spreading.