[Clostridium difficile-associated infections in a septic ward of a level 1 trauma centre: an analysis of 159 patients].

BACKGROUND

Clostridium difficile-associated infections are severe nosocomial infections. In recent studies, dramatic increases of CD-associated infections for the U.S.A. and Germany have been described, which leads to additional risk for patients and higher costs. Despite several studies, there is no study available which analyses the incidence of CD-associated infections on a septic ward at a level 1 trauma centre. Therefore, this study was performed to analyse the incidence and risk factors of developing a CD-associated infection in septic trauma patients.

MATERIAL AND METHODS

All patients treated between January 2002 and December 2009 at the septic ward of a level 1 trauma centre, who developed a CD-associated diarrhoea or pseudomembranous colitis, were included in this retrospective study. Information about age, sex, admission diagnosis, indication for antibiotic therapy, length of antibiotic therapy, number of administered antibiotics, length of hospital stay, type of treatment of the CD-associated infection as well as the mortality rate was gleaned from the patients' medical records. Furthermore, the relation of developing a CD-associated infection was determined for the following factors: (i) age > 65 years versus < 65 years; (ii) male versus female; (iii) single versus multiple antibiotic therapy; (iv) cephalosporins versus remaining antibiotic groups.

RESULTS

Between January 2002 and December 2009 6378 patients with surgical infection were treated at our level 1 trauma centre, whereas a total of 159 patients (2.5%) developed during the hospital stay a Clostridium difficile-associated diarrhoea. The incidence of CD-associated infection increased dramatically in 2009 and was more than quadrupled compared with 2002 or 2003. Patients over 65 years of age developed more frequently a CD-associated infection compared to patients less than 65 years of age (OR 1.96, 95% CI 1.4 to 2.7). There was no difference between males and females as well as between multiple antibiotic therapy and single antibiotic therapy (OR 0.96, 95% CI 0.7 to 1.3). Cephalosporins were the most often administered antibiotics with a median value of 45.9% followed by gyrase inhibitors with a median value of 17.2%. However, there were no differences between antibiotic groups (OR 1.11; 95% CI 0,87-1,5).

CONCLUSIONS

In conclusion, CD-associated infections are frequent nascent infections on a septic ward at a level 1 trauma centre. This could result in a therapeutic dilemma in the future, especially in septic surgery, where antibiotic therapy is an essential component of the therapy. Thus, further prospective clinical and experimental studies are essential.