Epidemiological characteristics of nosocomial diarrhea caused by Clostridium difficile in a tertiary level hospital in Serbia

Šuljagić, Vesna; Đorđević, Dragan; Lazić, Srđan; Mijović, Biljana

doi:10.2298/SARH1308482S

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Srpski arhiv za celokupno lekarstvo

2013, vol. 141, br. 7-8, str. 482-489

Epidemiološke odlike bolničkih proliva koje izaziva Clostridium difficile u ustanovi tercijarnog nivoa zdravstvene zaštite u Srbiji

Šuljagić Vesna^a

, Đorđević Dragan^b, Lazić Srđan^a, Mijović Biljana^c

^aUniverzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
^bVojnomedicinska akademija, Beograd
^cUniverzitet u Istočnom Sarajevu, Medicinski fakultet, Foča, Republika Srpska, BiH

e-adresa: suljagicv@yahoo.com

Ključne reči: bolesti povezane sa Clostridium difficile (CDAD); faktor rizika; epidemiologija; prevencija i suzbijanje

Sažetak

Uvod. Danas se među najznačajnije uzročnike proliva u bolničkoj sredini svrstava Clostridium difficile (C. difficile). Širok spektar oboljenja koje ova bakterija izaziva poznate su pod nazivom 'bolesti povezane sa C. difficile' (engl. Clostridium difficile associated disease - CDAD). Razvoju CDAD obično prethode primena antimikrobne terapije i fekalno-oralna infekcija bakterijom C. difficile. Poslednjih godina epidemiološka slika CDAD se značajno promenila. Nedavno je ustanovljen hipervirulentni epidemijski soj BI/NAP1/027, uzročnik teških epidemija u Severnoj Americi i Zapadnoj Evropi. Cilj rada. Cilj istraživanja je bio da se odredi učestalost faktora rizika za nastanak CDAD kod bolesnika operisanih u Vojnomedicinskoj akademiji (VMA). Metode rada. Ispitivanjem su obuhvaćene osobe operisane u VMA od 1. januara do 31. decembra 2010. godine. Primenjena je ugnežđena anamnestička studija. Ispitanici su svrstani u dve grupe: one sa CDAD i one bez CDAD (kontrolna grupa). Ispitanici su klinički praćeni prospektivno, a podaci o njima su prikupljani upitnikom tokom rutinskog epidemiološkog nadzora. Rezultati. Tokom 2010. godine stopa incidencije CDAD u VMA je bila 3,3 na 10.000 bolničkih dana. Univarijantna regresiona analiza je pokazala da su dužina primanja jednog antibiotika i dužina primanja dva antibiotika, kao i istovremeno primanje dva antibiotika, značajno češće uočeni kod bolesnika sa CDAD u odnosu na operisane bolesnike bez CDAD. Nezavisan faktor rizika za nastanak CDAD bila je dužina primanja jednog antibiotika. Zaključak. Smanjenje stope incidencije CDAD postiže se primenom pouzdanih mera prevencije i suzbijanja: racionalnom upotrebom antibiotika, ranim postavljanjem dijagnoze i lečenjem inficiranih osoba, njihovom kontaktnom izolacijom, pravilnom dezinfekcijom, te stalnom edukacijom medicinskog i nemedicinskog osoblja.

Abstract

Introduction. Among the most important causes of diarrhea in modern hospitals is Clostridium difficile (C. difficile). A wide spectrum of diseases caused by this bacterium is now known as C. difficile associated disease (CDAD). The development of CDAD is usually preceded by the administration of antimicrobial therapy and fecal-oral infections with C. difficile. Over the last years epidemiology of CDAD has significantly changed. Recently, a hypervirulent BI/NAP1/027 strain, the cause of severe epidemics in North America and Western Europe, has been identified. Objective. The aim of this study was to identify risk factors for CDAD in patients operated on at the Military Medical Academy (MMA). Methods. The study included all patients who underwent surgery at the MMA during 2010. Nested case-control study design was used. The subjects were divided into groups of operated patients with and without CDAD. The patients were under prospective follow-up, while their data were collected using a questionnaire during a routine epidemiological control. Results. During 2010 the incidence rate of CDAD was 3.3 per 10,000 hospital days. Univariate regression analysis showed that the length of administration of one or two antibiotics, as well as concurrent administration of two antibiotics, were far more frequently observed in the patients with than in the patients without CDAD. Independent risk factor for the development of CDAD was the length of the administration of one antibiotic. Conclusion Reduction in the incidence rate of CDAD can be achieved by using reliable measures of prevention and control; the rational use of antibiotics, early diagnosis and therapy of infected patients, contact isolation of infected persons, proper disinfection, and continued education of medical and non-medical personnel.

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O članku

jezik rada: srpski
vrsta rada: originalan članak
DOI: 10.2298/SARH1308482S
objavljen u SCIndeksu: 13.11.2013.

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