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Article Abstract
Background: Clostridioides difficile (C. difficile) Infection (CDI) is a major public health concern, causing a range of gastrointestinal diseases with increasing global incidence. In Italy, epidemiologic data on Clostridioides difficile CDI, particularly on community-acquired cases, are limited. This study aimed to provide population-based incidence data for CDI in Umbria, Italy, from 2014 to 2022, analyzing trends, demographics, recurrence rates, and 30-day all-cause mortality.
Methods: We used laboratory data from all regional public hospitals and local health units. CDI cases were C. difficile strains growing in culture and with toxin genes. The presence of toxin genes was confirmed by Xpert C. difficile Binary Toxin testing. Cases were categorized into hospital-acquired (HA-CDI) or community-acquired (CA-CDI). Incidence rates per 100,000 inhabitants per year were calculated. We analyzed incidence and 30-day mortality trends over a nine-year period. Logistic regression assessed predictors of 30-day mortality.
Results: 5955 CDI cases were identified (57.7 % female). Overall incidence increased from 48.1 cases per 100,000 inhabitants in 2014-88 cases in 2022 (CA-CDI rose from 25.2 to 39 and HA-CDI from 22.9 to 49.2). The 30-day mortality risk was 17.6 % (1045 deaths). In multivariable analysis, adjusted 30-day all-cause mortality risk was higher among HA-CDI patients compared to CA-CDI (OR 1.8, 95 % CI 1.6-2.1). 30-day mortality risk was also higher for elderly patients and male gender. Moreover, the mortality risk was stable over time. Recurrence occurred in 655 (11 %) of patients.
Conclusions: The worrisome finding of increasing incidence of CDI in all settings, including hospital, indicates the urgency of establishing a stable surveillance system for CDIs. Considering the unfavorable trend and high mortality, measures to reduce the risk of CDI would be indicated, particularly in hospital and elderly home care settings where vulnerable patients concentrate.
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