Pilot istraživanje Clostridium difficile infekcija u bolesnika s proljevom u zdravstvenim ustanovama u Tbilisiju, Gruzija

Abstract

Background: Clostridium difficile infection (CDI) is the most frequent cause of healthcare-associated diarrhoea and is increasingly recognized in the community. The epidemiology of CDI in Georgia is unknown. Methods: Pilot surveillance for CDI among patients with diarrhoea was conducted in four hospital ICUs, and three outpatient clinics in Tbilisi, Georgia. Demographic, clinical and treatment data of patients with CDI were collected from medical records. A CDI diagnosis was made if the stool sample was positive for C. difficile toxin A and/or B by nucleic acid amplification test or enzyme immunoassay, or by culture of a toxin-producing C. difficile. Results: A total of 131 patients with new onset diarrhoeal illness were recruited. Of these, laboratory confirmed CDI was found in 24% (31/131): 32% (17/53) of adult and 20% (11/55) of paediatric ICU patients, 22% (2/9) adult and 7% (1/14) of paediatric outpatients. Presenting symptoms were fever (>380C) and diarrhoea with a median duration 7 days. Most CDI cases received antibiotics before diagnosis; 94% of adults and 91% of children diagnosed in the ICU (median: 12 days); the majority receiving simultaneously two or more antibiotics. In the outpatient settings, 100% of CDI case-patients received an antibiotic for a median duration of 7 days. Conclusions: This pilot surveillance demonstrated that C. difficile is a common cause of diarrhoea in hospitalized and community patients in Georgia. It highlights the need to improve the knowledge of medical providers regarding the burden of CDI and to establish diagnostic testing at hospital laboratories.Uvod: Infekcije uzrokovane Clostridium difficile (CDI) najčešći su uzrok proljeva povezanog sa zdravstvenom skrbi i sve se više prepoznaju u zajednici. Epidemiologija C.difficile infekcija u Gruziji nije poznata. Metode: Pilot istraživanje C.difficile infekcija kod bolesnika s proljevom provedeno je u četiri bolničke jedinice za intenzivno liječenje (JIL) i tri ambulantne klinike u Tbilisiju u Gruziji. Podaci o demografskim i kliničkim karakteristikama te liječenju bolesnika s CDI prikupljeni su iz povijesti bolesti. Dijagnoza C.difficile infekcije postavljena je ukoliko je uzorak stolice bio pozitivan na C. difficile toksin A i/ili B testom amplifikacije nukleinskih kiselina ili metodom enzimskog imunoeseja ili nalazom C. difficile koji proizvode toksine u kulturi. Rezultati: U istraživanje je bio uključen 131 bolesnik s novonastalom dijarealnom bolesti. Od toga je laboratorijski dokazana CDI utvrđena kod 24% (31/131) bolesnika: u 32% (17/53) odraslih i 20% (11/55) djece liječene u JIL-u, 22% (2/9) odraslih i 7% (1/14) pedijatrijskih ambulantnih bolesnika. Simptomi su bili povišena tjelesna temperatura (> 38 ° C) i proljev s prosječnim trajanjem od 7 dana. Većina bolesnika s CDI primila je antibiotik prije postavljanja dijagnoze; 94% odraslih i 91% djece liječene u JIL-u (medijan: 12 dana); većina je istodobno primala dva ili više antibiotika. U ambulantnom okruženju, 100% bolesnika s CDI primilo je antibiotik u prosječnom trajanju od 7 dana. Zaključak: Ovo pilot istraživanje pokazalo je da je C. difficile čest uzrok proljeva u hospitaliziranih i izvanbolničkih pacijenata u Gruziji. Ono naglašava potrebu za poboljšanjem znanja pružatelja zdravstvenih usluga vezano uz probleme koje nose infekcije uzrokovane C. difficile te uspostavom dijagnostičkih testova u bolničkim laboratorijima