ISSN : 2146-3123
E-ISSN : 2146-3131

The Recent Emergence of Clostridium Difficile Infection in Romanian Hospitals is Associated With a High Prevalence of Polymerase Chain Reaction Ribotype 027
Gabriel Adrian Popescu1, Roxana Serban3, Adriana Pistol3, Andreea Niculcea3, Andreea Preda3, Daniela Lemeni4, Ioana Sabina Macovei4, Daniela Tălăpan2, Alexandru Rafila2, Dragoş Florea2
1Department of Infectious Diseases, National Institute for Infectious Diseases Matei Bals, Bucharest, Romania
2Department of Infectious Diseases, Carol Davila University of Medicine, Bucharest, Romania
3National Centre for Communicable Surveillance and Control, National Institute for Public Health, Bucharest, Romania
4Department of Microbiology and Immunology, “Cantacuzino” National Institute for Research, Bucharest, Romania
DOI : 10.4274/balkanmedj.2017.0400

Aims: To evaluate the epidemiology of Clostridium difficile infection in several Romanian hospitals.
Methods: A survey was conducted from November 2013 to February 2014 in 9 hospitals selected from different Romanian regions. 
Result: The survey identified 393 patients with C. difficile infection. The median age was 67 years (range: 2-94 years) with 56% of patients older than 65 years. The mean C. difficile infection prevalence was 5.2 per 10.000 patient-days, with the highest prevalence, 24.9 and 20 per 10.000 patients-days, reported in a gastroenterology and an infectious diseases hospital, respectively. The origin of C. difficile infection was health care-associated for 70.5% of the patients, community-acquired for 10.2% of patients and indeterminate for other 19.3%. Severe C. difficile infection was registred in 12.3% cases and in hospital all-cause mortality was 8.8%. Polymerase chain reaction-ribotype 027 was the most prevalent in all participating hospitals, and represented 82.6% of the total ribotyped isolates. Moxifloxacin minimal inhibitory concentrations were higher than 4 μg/mL for 59 of 80 tested isolates (73.8%). Fifty-four of these 59 isolates were highly resistant to moxifloxacin, (minimal inhibitory concentration ≥32 μg/mL) and belonged more frequently to polymerase chain reaction-ribotype 027 (p<0.0001). 
Conclusion: The present study is the first multicentre study performed in Romania and shows that the ribotype 027 is largely predominant in C. difficile infection cases in Romania. The prevalence of C. difficile infection in some specialized hospitals is higher than the European mean prevalence and demonstrates the need of strict adherence to infection control programmes.

Keywords : Clostridium difficile, epidemiology, ribotype 027, Romania
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