Epidemiology of Clostridioides difficile Infection in Portugal: A Retrospective, Observational Study of Hospitalized Patients

Authors

  • Cláudia Nazareth Unidade de Prevenção de Controlo de Infeções e Resistências aos Antimicrobianos. Centro Hospitalar e Universitário de Coimbra. Coimbra.
  • Inês Leitão Departamento de Doenças Infecciosas. Centro Hospitalar Universitário Lisboa Norte. Lisboa.
  • Ernestina Reis Serviço de Medicina Interna. Centro Hospitalar Universitário do Porto. Porto.
  • Hugo Inácio Serviço de Medicina 2.5. Centro Hospitalar Universitário Lisboa Central. Lisboa.
  • Filomena Martins Grupo Coordenador Local de Prevenção e Controlo da Infecção e Resistência aos Antimicrobianos. Centro Hospitalar Lisboa Ocidental. Lisboa.
  • Elmano Ramalheira Serviço de Patologia Clínica. Centro Hospitalar do Baixo Vouga. Aveiro.
  • Flávia Cunha Serviço de Doenças Infeciosas. Centro Hospitalar e Universitário de Coimbra. Coimbra.
  • Carla Santos Departamento de Doenças Infecciosas. Centro Hospitalar Universitário Lisboa Norte. Lisboa.
  • Sara Lino Serviço de Doenças Infeciosas. Centro Hospitalar Universitário Lisboa Central. Lisboa.
  • Hugo Moreira Serviço de Medicina. Centro Hospitalar de Lisboa Ocidental. Lisboa.
  • Nadiya Kruptsala Serviço de Patologia Clínica. Centro Hospitalar do Baixo Vouga. Aveiro.
  • Andrea Santos Departamento de Doenças Infeciosas. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisboa.
  • Laura Paixão Medical Affairs. Merck Sharp & Dohme Lda. Paço de Arcos.
  • Leonor Pássaro Medical Affairs. Merck Sharp & Dohme Lda. Paço de Arcos.
  • Mónica Oleastro Departamento de Doenças Infeciosas. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisboa.

DOI:

https://doi.org/10.20344/amp.15890

Keywords:

Clostridioides difficile, Clostridium Infections/epidemiology, Inpatients, Portugal

Abstract

Introduction: Clostridioides difficile is the main cause of healthcare-associated diarrhea in Europe and North America. The aim of this study was to characterize the epidemiology and clinical burden of Clostridioides difficile infection among hospitalized patients in Portugal.
Material and Methods: Retrospective study conducted in six public hospital centers in Portugal. All primary Clostridioides difficile infection episodes and related recurrences occurring in 2017, as well as episodes developing two to eight weeks after the last episode diagnosed in that year, were documented. The National Reference Laboratory (National Institute of Health Dr. Ricardo Jorge) provided national surveillance data on Clostridioides difficile infection.
Results: A total of 385 inpatients with at least one primary episode diagnosed in 2017 were included. Most patients were aged over 70 years-old (73.2%). The included patients developed 451 episodes during the observation period. Approximately 44% of primary episodes were community-associated. Most episodes (94.9%) occurred in patients with one or more risk factors, with recent antibiotic exposure being particularly common (86.0%). All-cause in-hospital mortality was 19.5%, being significantly higher in patients aged over 65 years-old versus those aged 18 to 64 years-old (22.4% vs 7.8%, respectively). Over 50 different ribotypes were observed among 206 Clostridioides difficile strains received by the National Reference Laboratory.
Conclusion: In Portugal, hospitalized patients with Clostridioides difficile infection are mostly older patients presenting risk factors for the development of this infection, particularly recent antibiotic exposure. Mortality is disproportionately high among the older population. Community-associated Clostridioides difficile infection is common among inpatients with this infection.

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Published

2022-04-01

How to Cite

1.
Nazareth C, Leitão I, Reis E, Inácio H, Martins F, Ramalheira E, Cunha F, Santos C, Lino S, Moreira H, Kruptsala N, Santos A, Paixão L, Pássaro L, Oleastro M. Epidemiology of Clostridioides difficile Infection in Portugal: A Retrospective, Observational Study of Hospitalized Patients. Acta Med Port [Internet]. 2022 Apr. 1 [cited 2024 Apr. 21];35(4):270-8. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/15890

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Original