CLOSTRIDIUM DIFFICILE IN DOLJ COUNTY (ROMANIA) – SURVEILLANCE INFORMATION 2015 TO 2016

Objectives. The paper aims epidemiological characteristics of the nosocomial infection with Clostridium difficile (CDIn) based on surveillance data reported by medical facilities in Dolj County (Romania). Methods. We performed a retrospective study (January 2015 – December 2016) of 506 files with declaration of cases of C. difficile infections (CDI) recorded in adults. Results. CDIn represented 83.7% of the cases of CDI, an increase from 13.8 cases/month in 2015 to 21.5 cases/month in 2016. The symptoms began after discharge in 46.6% of cases and during hospitalization for 53.4% of the reported cases. The illness origin was in 47.8% of cases in a medical unit different from the reporting one. The number of CDIn was higher in the infectious disease wards (0.73 cases/bed/year) and intensive care (0.3 cases/bed/year). The main risk factors were the antibiotics administration (87.1%) and the age over 60 (69.3% of cases). The lethality by CDIn was 2.1% and in 5.7% of the cases, death being produced by aggravation of the associated pathology. Conclusions. The implementation of the CDI surveillance contributed to Dolj County to improve monitoring and identification of the risk factors associated to this disorder

LITHIUM INTOXICATION IN INFECTIOUS CONTEXT OF A PATIENT ON CHRONIC LITHIUM THERAPY

Introduction. In the history of his usage, by the 1850`s, Lithium was first used for the treatment of the gout. As mania and melancholia were included in the same diagnostic group, Lithium started to be used for the treatment of mental disorders. Nowadays, Lithium is still used in the bipolar disorder and as adjuvant in depression, schizophrenia, schizoaffective disorder and for the control of child aggressiveness. Methods and objective. Reporting a case of Lithium Intoxication in a patient with infection and chronic treatment with Lithium Carbonate. Objectives. Reporting a case of Lithium Intoxication in a patient with streptococcal angina infection and chronic treatment with Lithium Carbonate. Conclusion. Lithium intoxication may be rare in medical practice because of rare usage of Lithium therapy and strict monitorization of serum concentration. In this case, the tonsillar infectious accompanied by fever, impossibility of proper oral hydration and impairment of renal functions were the initial trigger of the pathological mechanism of intoxication syndrome. Secondary, the excretion of Lithium decreased and the low serum volume led to high blood concentration of Lithium. Later on, the gastrointenstinal impairment which appeared slowly added to the vicious circle which involved hydration, excretion and serum concentration of Lithium producing and intoxication syndrome

IMPLICATIONS OF ANTIBIOTHERAPY IN CLOSTRIDIUM DIFFICILE INFECTION TO HOSPITALIZED PATIENTS IN DOLJ COUNTY (ROMANIA)

Objectives. The paper presents the role of the antibiotic treatment and of the favoring factors independent on the antibiotherapy, identified in the occurrence of Clostridium difficile infection (CDI) in hospitalized cases in Dolj County. Material and method. Two groups of patients were analyzed: the CDI AB group (178 cases of CDI that received antibiotic treatment) and the CDI non AB group (36 CDI cases which did not receive antibiotic treatment) recorded between July 2014 and December 2016). Results. The antibiotherapy was a significant risk factor, registered at 83.2% of the cases. The classes of antibiotics associated with the onset of CDI were cephalosporins (73.5% of cases), quinolones (24.2%), penicillins (13.4%), tuberculostatics (6.1%), carbapenems (5.6%). The cases came from the general surgery sections (25.2%), pneumophtiziology (16.8%), intensive care (13.5%), neurology (12.1%), nephrology (6.1%), orthopedics (6.1%), cardiology (4.2%), plastic surgery (4.2%), urology (3.7%). CDI non AB recorded a higher percentage compared to CDI AB in the Intensive care sections (30.6% versus 10.1%). The comparative analysis of the characteristics of the patients with CDI AB and CDI non AB did not reveal significant differences linked to the age, sex, interval between admission and onset of the symptoms, recent gastrointestinal surgery or taking antacids. Conclusions. The antibiotherapy is an important risk factor for CDI, cephalosporins and quinolones being frequently-involved. Being admitted to the intensive care unit and the severity of the underlying conditions had a significant role in the appearance of CDI in patients without exposure to antibiotics

ASPECTS OF COMMUNITARY-ACQUIRED CLOSTRIDIUM DIFFICILE INFECTION IN DOLJ COUNTY, ROMÂNIA

Long regarded as a hospital-associated and antibiotic use infection, Clostridium difficile infection (CDI) has seen an increasing incidence as a community-aquired infection over the last decade. Objectives. The paper follows the particularities of CDI with a community onset, depending on the community or nosocomial origin of the infection. Material and method. Three-year retrospective study (July 1, 2014 – June 30, 2017) of 767 confirmed cases with primary CDI, hospitalized in medical units in Dolj county (România). Two groups of patients with community-onset CDI were analyzed: CA-CDI group with community origin of the infection, and NA-CDIc group with nosocomial origin. Results. CDI with community onset was identified in 453 patients (59.1% of the total); of these, 106 (23.4%) had community origin (CA-CDI) and 305 (67.3%) nosocomial (NA-CDIc). CA-CDI has increased from 4.3% (2014) to 17.9% (2017) of the total CDI, with an average of 13.1% for the study period. Compared to hospitalacquired CDI, patients with community-acquired infection were younger (median age 57 years vs 65 years), more frequently women (58.4% vs 46.2%), with lower exposure to antibiotics (75.4% vs 85.9%), lower associated immunodepression (4.7% vs 18.6%) and mortality (0.9% vs. 5.5%). Conclusions. CDI epidemiology is dynamic, the actual size of community infection requiring further assessment. CA-CDI should be considered in the investigation of community diarrhea, even in the absence of traditional risk factors (hospitalization, advanced age, antibiotic treatment