Clostridium difficile infection at a geriatric acute-care hospital in Switzerland between 2008 and 2014: a retrospective cohort study

Introduction

Clostridium difficile infection (CDI) epidemiology has changed with an increase in incidence and severity, particularly among the elderly.

Objectives

We aim to describe CDI epidemiology and assess the effect of infection control measures in the geriatric hospital of Geneva University Hospitals.

Methods

Retrospective cohort study of CDI patients, identified via active surveillance of the infection control program, at a 300 bed acute-care geriatric hospital in 2008-2014. We analyzed CDI incidence, surveillance case definition (hospital-onset healthcare facility–associated, HO-HCFA), recurrence, demographics, antibiotic exposure, time at risk and in-hospital mortality. Positive tests ≤14 days of diagnosis were excluded. Cell cytotoxicity test was replaced by PCR detection of C. difficile toxin B in 01/2010. Infection control measures included contact precautions, environmental cleaning and single room policy. Overall antibiotic use was also analyzed.

Results

We identified 231 CDI cases resulting in mean incidence of 92.1 cases/10000 admissions. 194 cases (83.9%) were HO-HCFA. Mean age was 85 (+-7.3) years; 26.4% (n=61) were male. Mean CDI incidence (cases/10000 admissions/year) was 124.7(2008), 82.9(2009), 107.9(2010), 100.4(2011), 139.5(2012), 42.9(2013), 46.5(2014). Mean time at risk was 23.5 (IQR 6-34) days. 180 patients (77.9%) received any antibiotics and 59.3% (n=137) ”high-risk” antibiotics in the previous month. 46 patients (29.9%) had a recurrence at a mean of 25 days. In-hospital mortality was 34.4% (n=76). From 01/2011 to 03/2013 single-room policy for CDI cases was suspended. During this period CDI incidence was 115.6 cases/10000 admissions, compared to 39.2 cases/10000 admissions after policy reinstitution (IRR 3.02, 95% CI 2.01-4.53). Overall antibiotic use slightly decreased from 260 DDD/1000PD in 2008 to 218 DDD/1000PD in 2013.

Conclusion

We observed a low incidence of CDI at the acute care geriatric hospital after a peak in 2012. The decreasing trend is likely the result of multifaceted measures such as improved antibiotic use, improved environmental cleaning, hand hygiene promotion and reinstitution of a single-room policy.

Disclosure of interest

None declared.