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 Popescu1,2, Roxana Serban3, Adriana Pistol3, Andreea Niculcea3, Andreea Preda3, Daniela Lemeni4, Ioana Sabina Macovei4, Daniela Tălăpan1,2, Alexandru Rafila1,2, Dragoş Florea1,2
1Clinic of Infectious Diseases, National Institute for Infectious Diseases Matei Bals, Bucharest, Romania
2Department of Infectious Diseases, Carol Davila University School of Medicine, Bucharest, Romania
3National Centre for Communicable Surveillance and Control, National Institute for Public Health, Bucharest, Romania
4Clinic of Microbiology and Immunology, “Cantacuzino” National Institute for Research, Bucharest, Romania
DOI : 10.4274/balkanmedj.2017.0400

Abstract

Aims: To investigate the epidemiology of Clostridium difficile infection in Romanian hospitals.
Methods: A survey was conducted at nine hospitals throughout Romania between November 2013 and February 2014.
Results: The survey identified 393 patients with Clostridium difficile infection. The median age was 67 years (range: 2-94 years); 56% of patients were aged >65 years. The mean prevalence of Clostridium difficile infection was 5.2 cases per 10.000 patient-days. The highest prevalences were 24.9 and 20 per 10.000 patient-days in hospitals specializing in gastroenterology and infectious diseases, respectively. Clostridium difficile infections were health care-associated in 70.5% patients and community-acquired in 10.2%. The origin was not determined in 19.3%. Clostridium difficile infection was severe in 12.3% of patients, and the in-hospital all-cause mortality was 8.8%. Polymerase chain reaction ribotype 027 had the highest prevalence in all participating hospitals and represented 82.6% of the total ribotyped isolates. The minimum inhibitory concentration of moxifloxacin was >4 μg/mL for 59 of 80 tested isolates (73.8%). Of 59 isolates, 54 were highly resistant to moxifloxacin (minimum inhibitory concentration ≥32 μg/mL), and the majority were polymerase chain reaction ribotype 027 (p<0.0001).
Conclusion: The ribotype 027 was the predominant cause of Clostridium difficile infections in Romania. In some specialized hospitals, the prevalence of Clostridium difficile infection was higher than the European mean prevalence, and this demonstrates the need for strict adherence to infection control programs.

Keywords : Clostridium difficile, epidemiology, ribotype 027, Romania
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