Alkhawaja Safa, Abo Arisheh Tamer T, Acunin Rommel, Alawi Fadheela A, Sharaf Abdulrahman, Alawainati Mahmood, Alzamrooni Alaa M, Husain Husain A, Alsalah Sumaya
Internal Medicine, Salmaniya Medical Complex, Manama, BHR.
Infection Prevention and Control, Government Hospitals Bahrain, Manama, BHR.
Cureus. 2024 Apr 1;16(4):e57381. doi: 10.7759/cureus.57381. eCollection 2024 Apr.
Background infection (CDI) represents a significant healthcare challenge associated with antibiotic use and healthcare settings. While healthcare facility-onset CDI (HO-CDI) rates have been extensively studied, the incidence and risk factors of CDI in various settings, including the community, require further investigation. Aim This study aims to examine the incidence rates of CDI in a major governmental hospital in Bahrain, identify risk factors for CDI, and assess the effectiveness of infection control measures. Method We conducted a retrospective study at the Salmaniya Medical Complex (SMC), analyzing all confirmed cases of CDI over a 30-month period from January 2021 to June 2023. CDI cases were screened using glutamine dehydrogenase antigen detection and confirmed using molecular assays like polymerase chain reaction and/or toxin assays for confirmation. The study categorized CDI cases based on their onset (hospital or community) and explored associated risk factors, including antibiotic use, proton pump inhibitor (PPI) therapy, and patient demographics. Infection control practices were also evaluated for their role in managing CDI. Results About 57 new CDI cases were identified during the study period, with a HO-CDI incidence rate of 0.5 per 10,000 patient days. While HO-CDI rates remained stable, community-onset (CO)-CDI cases increased. The median patient age was 61.8 years, without notable differences between genders. Key risk factors for CDI were antimicrobial therapy, use of acid-reducing agents, age, and underlying comorbidities. The mortality rate stood at 35.1%. The ATLAS score (i.e., age, treatment with antibiotics, leukocyte count, albumin level, and serum creatinine) was a reliable predictor of mortality. Critical care admission and low albumin levels emerged as significant independent risk factors for mortality. Conclusions The study demonstrates a low incidence rate of HO-CDI at SMC, attributed to effective infection control and antibiotic stewardship programs. The overall CDI rate increased during the study period, driven by a rise in CO cases; further investigating the risk factors among this category in our study revealed that most patients were exposed to antibiotic therapy within the past three months of their CDI diagnosis. The rise in CO-CDI cases underscores the need for broader community-based interventions and awareness regarding antibiotic and PPI use.
背景 艰难梭菌感染（CDI）是与抗生素使用及医疗机构环境相关的一项重大医疗挑战。虽然医疗机构获得性CDI（HO-CDI）的发生率已得到广泛研究，但包括社区在内的各种环境中CDI的发病率及风险因素仍需进一步调查。目的 本研究旨在调查巴林一家主要政府医院的CDI发病率，确定CDI的风险因素，并评估感染控制措施的有效性。方法 我们在萨勒曼尼亚医疗中心（SMC）开展了一项回顾性研究，分析了2021年1月至2023年6月这30个月期间所有确诊的CDI病例。使用谷氨酰胺脱氢酶抗原检测对CDI病例进行筛查，并使用聚合酶链反应和/或毒素检测等分子检测方法进行确诊。该研究根据CDI病例的发病情况（医院或社区）进行分类，并探究相关风险因素，包括抗生素使用、质子泵抑制剂（PPI）治疗以及患者人口统计学特征。还评估了感染控制措施在管理CDI中的作用。结果 在研究期间共确定了约57例新的CDI病例，HO-CDI发病率为每10000患者日0.5例。虽然HO-CDI发病率保持稳定，但社区获得性（CO）-CDI病例有所增加。患者中位年龄为61.8岁，性别间无显著差异。CDI的主要风险因素为抗菌治疗、使用抑酸剂、年龄以及基础合并症。死亡率为35.1%。ATLAS评分（即年龄、抗生素治疗、白细胞计数、白蛋白水平和血清肌酐）是死亡率的可靠预测指标。重症监护病房入院及低白蛋白水平是死亡率的显著独立风险因素。结论 该研究表明SMC的HO-CDI发病率较低，这归因于有效的感染控制和抗生素管理计划。在研究期间，总体CDI发病率有所上升，这是由CO病例增加所致；对我们研究中这一类别中的风险因素进一步调查发现，大多数患者在CDI诊断前三个月内接受了抗生素治疗。CO-CDI病例的增加凸显了开展更广泛的基于社区的干预措施以及提高对抗生素和PPI使用的认识的必要性。
