Clostridioides difficile iðrasýkingar á Landspítala 2017-2022

Abstract

Tilgangur Að kanna faraldsfræði, alvarleika, meðferð og horfur sjúklinga með Clostridioides difficile iðrasýkingar (CDI) sem greindust á Landspítala árabilið 2017-2022. Efniviður og aðferðir Rannsóknarþýðið voru fullorðnir sjúklingar á Landspítala með tvíjákvæð (PCR + ELISA) greiningarpróf. Ef sami sjúklingur var með tvö eða fleiri jákvæð sýni innan 28 daga tímabils voru seinni sýnin talin endurspegla sömu sýkingu. Niðurstöður Alls greindust 358 sýkingar hjá 301 sjúklingi. Meiri hluti sýkinga greindist meðal kvenna (59,5%). Meðalnýgengi heilbrigðistengdra CDI á tímabilinu var 3,23 sýkingar/10.000 legudagar á vefrænum deildum Landspítala. Nýgengi samfélagstengdra CDI var 0,57 sýkingar/10.000 íbúa höfuðborgarsvæðisins. Nýgengið fylgdi hækkandi aldri og hélst svipað í gegnum rannsóknartímabilið. Endursýkingar greindust hjá 15,3% og meðaleftirfylgnitími var 1,6 persónuár. Að minnsta kosti 85,5% sjúklinga höfðu tekið sýklalyf innan mánaðar fyrir greiningu og höfðu flestir tekið lyf af flokki penicillína (57,8%) og þar á eftir úr flokki cefalósporína (51,5%). Ríflega helmingur sjúklinga (54,7%) hafði notað prótónupumpuhemla áður en sýkingin greindist. Algengasta upphafsmeðferð við CDI var metrónídazól (63,0%). Af þeim hópi þurftu 29,4% á frekari meðferð að halda innan 28 daga frá upphafi meðferðar. Hægðaflóruflutningur var framkvæmdur í 13 tilfellum. Heildardánartíðni innan 30 daga frá greiningu var 7,3%. Ályktanir Nýgengi C. difficile iðrasýkinga á Landspítala hélst stöðugt yfir rannsóknartímabilið og var sambærilegt og á sjúkrahúsum í Evrópu. Flestir þeirra sem sýktust höfðu einn eða fleiri áhættuþátt. Flestir fengu meðferð með sýklalyfjum og var metrónídazól þar algengast. Niðurstöður þessarar rannsóknar benda til að nýgengi sýkingarinnar sé stöðugt og birtingarmynd hennar hafi lítið breyst, en nýir meðferðarmöguleikar lofa góðu.

Objective: To investigate the epidemiology, severity, treatment, and prognosis of patients with C. difficile infections (CDI) diagnosed at Landspítali University Hospital from 2017-2022. Materials and Methods: The study population consisted of adult patients at Landspítali with double-positive (PCR + ELISA) diagnostic tests. If the same patient had two or more positive samples within a 28-day period, they were considered to reflect the same infection, and the latter samples were excluded. Results: Overall, 358 CDI were identified in 301 patients. The majority of cases were diagnosed in women (59.5%). The incidence of healthcare-associated CDI was 3.23 infections/10.000 in-hospital days (range 2.65 - 3.26). Incidence of community-associated CDI was 0.57 infections/10.000 inhabitants of the Reykjavik metropolitan area. Incidence was positively correlated with increasing age and remained similar throughout the study period. The recurrence rate during the study period was 15.3% with a mean follow-up period of 1.6 person-years. At least 85.5% of patients had taken antibiotics within a month before diagnosis, most commonly from the penicillin class (57.8%), followed by cephalosporins (51.5%). More than half (54.7%) of patients had taken proton pump inhibitors preceding diagnosis. Metronidazole was the most common initial treatment (63.0%). Of these, 29.4% of cases required further treatment within 28 days of treatment start. Fecal microbiota transplantation was performed in 13 cases. The 30-day all-cause mortality rate was 7.3%. Conclusions: The incidence of CDI at Landspítali has remained stable and comparable to what has been reported in Europe during the same period. Most patients had one or more risk factors present. Most received antibiotics as treatment, most commonly metronidazole. The results of this study indicate that incidence and clinical presentation of CDI in Iceland are stable, whilst novel treatment options look promising.