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Travel Medicine and Infectious Disease
Available online 15 July 2012
Epidemiological features of Clostridium difficile infection among inpatients at Hamad General Hospital in the state of Qatar, 2006?2009
Fahmi Yousef Khana, Corresponding author contact information, E-mail the corresponding author,
Mohammed Abu-Khattabb,
Deshmukh Anandc,
Khalid Baagera,
Ahmed Alainia,
Mashhood A. Siddiquea,
Shehab Fareed Mohameda,
Mir I. Alia,
Mamoon M. Al bedawid,
Mohamed S. Nasere
a Department of Medicine, Hamad General Hospital, P.O. Box: 3050, Khalifa Street, Doha, Qatar
b Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Qatar
c Microbiology Laboratory, Hamad General Hospital, Qatar
d Well Cornel Medical Collage-Qatar, Qatar
e Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Qatar
Received 19 January 2012. Revised 16 June 2012. Accepted 25 June 2012. Available online 15 July 2012.
http://dx.doi.org/10.1016/j.tmaid.2012.06.004,
Summary
The aim of this retrospective study was to evaluate the epidemiology, clinical course and outcome of Clostridium difficile infection among inpatients at Hamad General Hospital in Qatar, from 2006 to 2009. During this period, 123 patients were diagnosed with C. difficile infection and the overall incidence was 1.6/10,000 patient days. The mean age (?SD) of patients was 50.9 ? 21.2 years. The most frequent underlying disease was hypertension 51/123 (41.5%) and 133 prescriptions of antimicrobials were ordered for 105/123 (86.1%) patients prior to C. difficile infection with piperacillin-tazobactam being the most frequently prescribed antimicrobial 39/131 (29.7%). Nosocomial infection was found in 101/123 (82.0%) of cases, and the most common clinical feature was watery diarrhoea 119/123 (96.7%). Antimicrobials were discontinued in 53/105 (50.5%) cases and 118/123 (95.9%) of them received metronidazole as the initial treatment. The mean treatment duration (?SD) was 9.08 ? 5.6 days. Fifteen (12.7%) patients failed the first course of antimicrobial therapy, of which four were treated with oral vancomycin, and eleven patients received both drugs. Recurrence of infection was observed in 12/118 (10.2%) patients and 30-day mortality was 38/123 (30.9%). Several clinical variables were associated with increased 30-day mortality on univariate analysis. Only occurrence of disease among Qataris, prolonged hospitalisation, positive stool occult blood test, high white blood cells and septic shock were found to be independent predictors of mortality by multivariate logistic regression analysis. In conclusion, C. difficile infection was a recognise cause of morbidity and mortality in our hospital with low and stable incidence. It involved predominantly patients younger than 65 years with underlying illness and metronidazole and vancomycin were effective in resolving symptoms in the majority of our patients.
Available online 15 July 2012
Epidemiological features of Clostridium difficile infection among inpatients at Hamad General Hospital in the state of Qatar, 2006?2009
Fahmi Yousef Khana, Corresponding author contact information, E-mail the corresponding author,
Mohammed Abu-Khattabb,
Deshmukh Anandc,
Khalid Baagera,
Ahmed Alainia,
Mashhood A. Siddiquea,
Shehab Fareed Mohameda,
Mir I. Alia,
Mamoon M. Al bedawid,
Mohamed S. Nasere
a Department of Medicine, Hamad General Hospital, P.O. Box: 3050, Khalifa Street, Doha, Qatar
b Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Qatar
c Microbiology Laboratory, Hamad General Hospital, Qatar
d Well Cornel Medical Collage-Qatar, Qatar
e Medical Intensive Care Unit, Department of Medicine, Hamad General Hospital, Qatar
Received 19 January 2012. Revised 16 June 2012. Accepted 25 June 2012. Available online 15 July 2012.
http://dx.doi.org/10.1016/j.tmaid.2012.06.004,
Summary
The aim of this retrospective study was to evaluate the epidemiology, clinical course and outcome of Clostridium difficile infection among inpatients at Hamad General Hospital in Qatar, from 2006 to 2009. During this period, 123 patients were diagnosed with C. difficile infection and the overall incidence was 1.6/10,000 patient days. The mean age (?SD) of patients was 50.9 ? 21.2 years. The most frequent underlying disease was hypertension 51/123 (41.5%) and 133 prescriptions of antimicrobials were ordered for 105/123 (86.1%) patients prior to C. difficile infection with piperacillin-tazobactam being the most frequently prescribed antimicrobial 39/131 (29.7%). Nosocomial infection was found in 101/123 (82.0%) of cases, and the most common clinical feature was watery diarrhoea 119/123 (96.7%). Antimicrobials were discontinued in 53/105 (50.5%) cases and 118/123 (95.9%) of them received metronidazole as the initial treatment. The mean treatment duration (?SD) was 9.08 ? 5.6 days. Fifteen (12.7%) patients failed the first course of antimicrobial therapy, of which four were treated with oral vancomycin, and eleven patients received both drugs. Recurrence of infection was observed in 12/118 (10.2%) patients and 30-day mortality was 38/123 (30.9%). Several clinical variables were associated with increased 30-day mortality on univariate analysis. Only occurrence of disease among Qataris, prolonged hospitalisation, positive stool occult blood test, high white blood cells and septic shock were found to be independent predictors of mortality by multivariate logistic regression analysis. In conclusion, C. difficile infection was a recognise cause of morbidity and mortality in our hospital with low and stable incidence. It involved predominantly patients younger than 65 years with underlying illness and metronidazole and vancomycin were effective in resolving symptoms in the majority of our patients.
