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. 2017 Oct;45(5):621-628.
doi: 10.1007/s15010-017-1024-1. Epub 2017 May 11.

Assessing the risk and disease burden of Clostridium difficile infection among patients with hospital-acquired pneumonia at a University Hospital in Central China

Chunhui Li  1 , Juping Duan  1   2 , Sidi Liu  1 , Xiujuan Meng  1 , Chenchao Fu  1 , Cui Zeng  1 , Anhua Wu  3
Affiliations

Assessing the risk and disease burden of Clostridium difficile infection among patients with hospital-acquired pneumonia at a University Hospital in Central China

Chunhui Li et al. Infection. 2017 Oct.

Abstract

Purpose: Hospital-acquired pneumonia (HAP) remains one of the major hospital-acquired infections in China. Antibiotic treatment of HAP may lead to subsequent Clostridium difficile infection (CDI). Baseline data on the occurrence of CDI among HAP patients in China are currently unavailable. This study examines the risk and disease burden of CDI among HAP hospitalized patients (HAP-CDI).

Methods: We conducted a prospective study among ICU patients with HAP and hospital-onset diarrhea from January 2014 to December 2014 in a teaching hospital in China. All stool specimens were cultured for C. difficile which were typed by MLST. We used univariate and multivariable regression analyses to identify risk factors of HAP-CDI.

Findings: In total, 369 patients who met the inclusion criteria were enrolled. Thirty-two patients tested C. difficile positive. Among the isolated C. difficile strains, 90.63% (29/32) isolates were toxinogenic. Various MLST types were identified. The incidence of HAP-CDI was 11.67/10,000 patient days (95% CI, 7.97-16.55). Nineteen patients died from complications. The attributable mortality rate was 5.15% (19/369). The mortality rate of HAP-CDI group was 13.79% which was higher than HAP-non-CDI group. Univariate analyses demonstrated that old age, receiving antibiotics (OR = 8.70) and glucocorticoids (OR = 7.71) 1 month prior to hospitalization, respiratory failure (OR = 3.28) and receiving antimicrobials during hospitalization (OR = 1.15) were the risk factors associated with CDI. Multivariate conditional logistic regression analysis demonstrated the similar results.

Conclusion: CDI was common among patients discharged from hospital for HAP at a university hospital. Prevention of the spreading of C. difficile among hospitalized patients is urgently needed.

Keywords: Broad-spectrum antibiotics; Clostridium difficile infection (CDI); Disease burden; Hospital-acquired pneumonia.

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Conflict of interest statement

Conflict of interest

All authors reviewed and approved the final manuscript. And all authors report no potential conflicts of interest.

Ethical statement

All procedures performed in this study involving human participants were in accordance with the Ethics Committee of the Xiangya Hospital of Central South University (No. 201312014). The study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all individual participants included in the study.

Human and animal participants

This article does not contain any studies with animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Enrollment of 29 HAP with C. difficile infection (CDI) patients and 340 HAP without CDI patients during 12 months of surveillance (from January 2014 to December 2014) in Xiangya Hospital, China
Fig. 2
Fig. 2
Compared dose per day per patient for extended-spectrum cephalosporins (a), oxacephems (b) and vancomycin (c) using among HAP-CDI and HAP-non-CDI group patients
See this image and copyright information in PMC

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