dr. sc. NOVAK ANITA dr. med.
„CLINICAL AND MICROBIOLOGICAL CHARACTERISTICS OF Clostridium Difficile INFECTIONS IN SPLIT UNIVERSITY HOSPITAL CENTER"
prof. dr. sc.TONKIĆ MARIJA
Qualifying research publications:
Anita Novak, Patrizia Spigaglia, Fabrizio Barbanti, Ivana Goic-Barisic,
Marija Tonkic. First clinical and microbiological characterization of Clostridium
difficile infection in a Croatian University Hospital. Anaerobe. 2014 Dec;30:18-23
IF (JCR 2014) 2.479
Clostridium difficile is the leading cause of nosocomial antibiotic-associated diarrhoea
in developed countries. The present study was undertaken in order to obtain clinical
and molecular overview of Clostridium difficile infection (CDI) in the University Hospital
All patients (n=54) with a first episode of clinical picture compatible with CDI
and microbiological evidence of toxin-producing C. difficile in stool, from January 2010
to December 2011, were included in the study. Thirty one patients (57.4 %) had chronic
underlying diseases and nineteen patients (35.2 %) had undergone surgery prior to CDI.
Six patients (11.7 %) had suffered one or more recurrences and 37 patients (72.5 %)
showed severe CDI.
Fifty four strains were isolated and 50 of them were available for PCR-ribotyping.
Sixteen different PCR-ribotypes were identified and two new PCR-ribotypes were detected
(PRO2844 and PRO2845). The most prevalent were PCR-ribotype 001 (27.8 %) and
014/020 (24.1 %). Severe CDI was associated with fourteen different PCR-ribotypes (including
new PRO2844 and PRO2845).
Fifteen severe CDI cases (40.5 %) were caused by strains resistant to
fluoroquinolones. The frequency of strains resistant to these antibiotics was significantly
higher in patients that received fluoroquinolones prior to the onset of CDI. Among 23
resistant strains, three (13.0 %) - all PCR-ribotype 001- were multi-resistant. Selective
pressure derived from the extensive use of quinolones in University Hospital Centre Split
could explain the predominance of strains resistant to these antibiotics observed in the
study, underlining the need for a more careful use of antibiotics.
Statistical analysis showed a strong correlation between severe CDI and prior treatment
with a third generation cephalosporin, malignancy and surgery. Awareness and
better antibiotic stewardship among surgical and oncologic patients could prevent developmentof severe CDI in the future.