P032: Clostridium difficile infection in Tenerife Canary Island, Spain

Abstract

Introduction: Clostridium difficile infections(CDI) epidemiology has changed: elevation in rate and severity of infection and increase in disease among outpatients. Objectives: Aim of study was to evaluate the epidemiology of CDI in North Tenerife Area. Methods: This is an epidemiological study performed in the Hospital Universitario de Canarias a tertiary care institution during 2011-2012. Studied population was outpatients or inpatients attended in this hospital with CDI suspected. Diagnostic procedures were based in GDH and later Toxin A/B detection as CDI confirmation in stool samples by EIA. Medical charts of patient were reviewed to collect: demographic variables, underlying diseases (diabetes(D), renal disease(RD), liver disease(LD), respiratory disease(ReD), cardiopathy(C), neoplasia(N)), >3 co-morbidities, inflammatory boweldisease(IBD), solidorgan transplant(OST), immunocompromised states(IC), treatment previous, treatment of CDI, developed to Pseudo-membranous colitis(PMC), mortality due to CDI. The episodes were classificated as nosocomial, healthcare associated (HCA), community, indeterminate, and recurrence. Results: In 2011/2012 a total 18/45 episodes (17/41 patients) were diagnosticated. 50/62% were man and 7/22 (39/49%), <65 years. HCA and nosocomial CDI incidence were: 0, 7/1, 7 case/104 patient-day. The services distribution was:Internal Medicine 6/12(33/27%), Nephrology 6/4(33/9%), Hematology 2/5(11/11%). Episodes: Community 4/7(22/15%), Nosocomial 14/27(78/60%), HCA 0/6(0/13%), Indeterminate 0/1(0/2%) and recurrences 0/4 (0/9%). In Nosocomial the time average between admission and CDI diagnostic was 10,6+/-9, 1/24+/-29 d. Underlying diseases: C 10/9(55/20%), RD 5/10(27,7/22%), LD 2/4(11/9%), ReD 2/2(11/4%), N2/10(11/22%). >3 comorbidities 3/3(17/7%). IBD 1/1(6/2%), OST 7/3(39/6,6%),IC 10/20(55/44%), previous treatment: Omeprazol 6/10(33/22%), Ranitidine 3/1(17/2%), Aciclovir 1/2(5,6/4,4%), Carbapenems 6/21(33/47%), Fluorquinolones 5/13 (28/29%), Cephalosporins (3-4a) 4/11 (22/24%), Vancomycin(VA) 3/6(17/13%), Amoxicillin-clavunate 2/7(11/16%). CDI Treatment: Metronidazole 18/39(100/ 87%), VA 3/9 (17/20%), developed PMC 2/5(11/11%), death for CDI 1/0. Conclusion: In our hospital there has been an increase in nosocomial CDI adquisition overtime and a high percentage in young patients. At 2012 OST patients declined and HCA episodes were increased thus we observed that CDI is not confined to hospitals