Clostridium Difficile Associated Disease: Burden of and Predictors for in Hospital Fatal Outcome. Results of a Hospital-Based Study, Bucharest, Romania

In the last 15 years Clostridium difficile infection became a typical new emergent threat worldwide. Our aim was to describe the risk factors associated with fatal outcome of Clostridium difficile associated disease (CDAD) cases treated in 2012 in "Dr Victor Babes" Infectious and Tropical Diseases Hospital, a 450 beds teaching clinic from Bucharest, Romania. Retrospective cohort study - the case records of hospitalized patients in the year 2012, presenting with diarrhea and that tested positive for C difficile through toxin A and B assays were reviewed. Data collected through chart review of CDAD were demographic and clinical. A Charlson comorbidities index score was allocated to each case. An EpiInfo data base was fed with demo and clinical data - software's facilities were used for univariate analysis (Chi square) and also for logistic regression. In study were included all 326 hospitalization episodes with a discharge diagnosis of CDAD in 2012. Overall, 30 of the 326 CDAD patients (9.2%) versus 289 of the 18636 non-CDAD patients (1.55%) died during their hospital stay, resulting in a relative risk of pre-discharge death of 5.93 (4.14- 8.50) for CDAD patients, a CDAD attributable risk of death of 7.65 per 100 patients and a CDAD attributable fraction of 83.15 % (70.1-86%). Unconditional logistic regression retained as fatal outcome predictors the following: (a) a Charlson comorbidity index score >3: (OR: 3.03; CI 95%: 1.21-7.54), (b) ICU stay: (OR: 15.81; CI 95%: 4.47- 55.89) and (c) age >64 years: (OR: 2.95; CI 95%: 1.15-7.69). Our findings add to the understanding of Clostridium difficile fatal outcome and they have implications for prevention and therapy - the case fatality of 9.2% underlines the importance of the increased efforts in CDAD prevention.