Regional epidemiologic data call for enhanced attention to Clostridioides difficile infections in Italy: Results from a population-based study

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-08-08 DOI:10.1016/j.jiph.2025.102928

Fabrizio Stracci , Camilla Gobbetti , Gaia Baccarini , Chiara Lupi , Antonella Mencacci , Gabrio Bassotti , Pierfrancesco Marconi , Katia Fettucciari , Silvia Leite , Alessio Gili , CLOS working group

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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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区域流行病学数据呼吁加强对意大利艰难梭菌感染的关注：一项基于人群的研究结果

艰难梭菌（C. difficile）感染（CDI）是一个主要的公共卫生问题，引起一系列胃肠道疾病，全球发病率不断上升。在意大利，关于艰难梭菌CDI的流行病学数据，特别是关于社区获得性病例的数据有限。该研究旨在提供2014年至2022年意大利翁布里亚地区基于人群的CDI发病率数据，分析趋势、人口统计学、复发率和30天全因死亡率。方法采用所有地区公立医院和地方卫生单位的实验室数据。CDI病例为带毒素基因的艰难梭菌培养株。采用Xpert艰难梭菌双毒素试验证实毒素基因的存在。病例分为医院获得性（HA-CDI）和社区获得性（CA-CDI）。计算了每年每10万居民的发病率。我们分析了9年期间的发病率和30天死亡率趋势。Logistic回归评估了30天死亡率的预测因素。结果共检出CDI病例5955例（女性57.7 %）。总体发病率从2014年的每10万居民48.1例增加到2022年的88例（CA-CDI从25.2例增加到39例，HA-CDI从22.9例增加到49.2例）。30天死亡风险为17.6 %（1045例死亡）。在多变量分析中，与CA-CDI患者相比，HA-CDI患者调整后的30天全因死亡率风险更高（OR 1.8, 95 % CI 1.6-2.1）。老年患者和男性的30天死亡风险也更高。此外，随着时间的推移，死亡风险是稳定的。655例（11. %）患者出现复发。结论令人担忧的是，包括医院在内的所有机构的CDI发病率都在上升，这表明建立稳定的CDI监测系统的紧迫性。考虑到不利的趋势和高死亡率，应采取措施减少CDI的风险，特别是在医院和老年人家庭护理环境中，弱势患者集中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.