RISK FACTORS FOR THE DEVELOPMENT OF CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA IN A THERAPEUTIC HOSPITAL

DOI: 10.22138/2500-0918-2018-15-5-724-732

Y.N. Yarushina, G.B. Kolotova, V.A. Rudnov

City Clinical Hospital № 40, Yekaterinburg, Russian Federation;
Ural state medical university, Yekaterinburg, Russian Federation

Abstract. Background: To identify risk factors of the development of antibiotic-associated diarrhea related to Clostridium difficile infection in patients of the therapeutic clinic in a multi-specialiry hospital. Materials and methods: a retrospective analysis was made of 110 patients, who were hospitalized in therapeutic department in Municipal Autonomus Institution «City Clinical Hospital № 40» in Yekaterinburg from 2014 to 2015 years, who had diarrhea developed on the background of antibacterial therapy. According to the results of the data obtained through studies of coprofiltrates on Clostridium difficile, the patients were divided into 2 groups: 60 patients with a positive result, and 50 patients with a negative result. Results: the proportion of patients with CD-infection in the department of therapy in MAI «City Clinical Hospital № 40», according to the data of the 2014-2015 years, amounted to 0,42%. The predictors of the risk of the development of CD-infection in patients are age of patients older than 65 years old (OR=4,33, 95% CI 1,15 to 16,20, p=0,028), Charlson comorbidity index of 2 points or more (OR=3,05, 95% CI 1,29 to 7,23, p=0,016), the presence of anemia (OR=2,32, 95% CI 1.07 to 5.02, p=0,048), chronic dialyzing of patients with chronic renal failure (OR=8,64, 95% CI 1,05 to 70,81, p=0,020), the stay of patients in hospital more than 5 days (OR=3,50, 95% CI 1,57 to 7,75, p=0,003) and hospitalization in the ICU lasting more than 1 day (OR=9,80, 95% CI 1,20 to 79,47, p=0,011), the use PPI (OR=2,82, 95% CI 1,12 to 7,11, p=0,041), holding antibacterial therapy for more than 10 days (OR=39,62, 95% CI 10,85 to 144, 71, p<0,001), holding more than 1 course of antibiotic therapy (OR=2,85, 95% CI 1,20 to 6,76, p=0,026). Conclusions: risk factors for the development of CD-infection are age older than 65 years old and multiple comorbidities (Charlson index more than 2 points), chronic renal failure requiring hemodialysis, and anemia, hospitalization in the ICU, the use of PPI, holding more than 1 course of antibiotic therapy and the duration of antibacterial therapy for more than 10 days.

Keyword: risk factors, Clostridium difficile, therapeutic clinic

There is no conflict of interest.

Contact information of the author responsible for correspondence:
Yadviga N. Yarushina
yarushina.ya@yandex.ru

Received 11.05.2018

For citation:
Yarushina Y.N., Kolotova G.B., Rudnov V.A. Risk factors for the development of clostridium difficile-associated diarrhea in a therapeutic hospital. Vestn. Ural. Med. Akad. Nauki. = Journal of Ural Medical Academic Science. 2018, Vol. 15, no. 5, pp. 724–732. DOI: 10.22138/2500-0918-2018-15-5-724-732 (In Russ)

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Authors
Yadviga N. Yarushina
doctor gastroenterologist, gastroenterology department,
yarushina.ya@yandex.ru

Galina B. Kolotova
Doctor of Medicine, deputy chief physician for a medical care
kolotova@gkb40.ur.ru

Vladimir A. Rudnov
Doctor of Medicine, professor
Head of the department of anesthesiology and intensive care
Deputy chief physician for anesthesiology and intensive care
vrudnov@mail.ru

Municipal autonomous institution «City Clinical Hospital № 40»
Russian Federation, 620102, Yekaterinburg, Volgogradskaya str., 189.