1382. Changing epidemiology of healthcare-associated Clostridium difficile infection from 3 years study in Korea
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • 2013-IDSA-Ȯ-2.pdf (334.4 kB)
  • Background: The objective of this study was to investigate the change in incidence, severity, and molecular epidemiology of healthcare-associated Clostridium difficileinfection (HA-CDI) in a tertiary hospital in Korea.

    Methods: From Feb 2009 through Jan 2012, confirmed HA-CDI patients were enrolled in our study at a 900-bed tertiary care facility located in Seoul, Korea. With cultured C. difficile organisms, PCR-ribotyping was performed and checked visually. Medical information was collected retrospectively including age, sex, and underlying disease. Disease severity of HA-CDI was scored as sum of each point of fever, leukocytosis, hypoalbuminemia, and age over 60 years old. Yearly data (from February to January next year) were compared among 3 periods.

    Results: Median incidence of HA-CDI was 69.8 per 105 pt*days, monthly incidence varying from 34.40 to 162.26/105pt*days, but there was no significant difference in incidence among 3 periods. The highest incidence was detected on May 2010 with predominant isolation of PCR ribotype 018 strains (62.5%). Comparing the distribution of PCR ribotypes among 3 periods, period 1 showed variable PCR ribotype with 001 (15%), 017 (16%), and 018 (26%), period 2 was characterized by 2-fold increase of PCR ribotype 017 strains, and persistence of dominant 017 ribotype strains in the 3rd year (16%, 34%, 30%, each period). The proportion of ribotype 018 strains was maintained through 3 years. During the study period, 16 cases of HA-CDI by binary toxin producing strains occurred.

    Severity score differed by period (P=0.035); leukocytosis and old age were significantly higher in period 3 than in period 1. Presence of pseudomembrane was not different by period (37.8%, 54.8%, 38.0%, each period, p for trend=0.983). Recurrence rate was 21.6%, 19.8%, and 20.7% in each period, respectively and cure rate without recurrence was 59.8%, 63.5%, and 57.6% without significant difference (p for trend=0.863, 0.768, respectively). Among all HA-CDI patients, 30-day mortality rate was 5.5%, 3.3%, and 10.7% and attributable mortality was 0.6%, 1.6%, and 0.6% in each year (pfor trend=0.051, 0.983).

    Conclusion: During 3 years, molecular epidemiology of HA-CDI has been changing with increased disease severity. However, treatment outcome and mortality were not different in each period.

    Jieun Kim, MD1, Hyunjoo Pai, MD2, Mi-Ran Seo3, Jung Oak Kang, MD4 and Tae Yeal Choi, MD4, (1)Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea, (2)Div. Infectious Diseases, Dept. of Internal Medicine, Hanyang University Hospital, Seoul, South Korea, (3)Div. Infectious Diseases, Hanyang University Hospital, Seoul, South Korea, (4)Department of Laboratory Medicine, Hanyang University College of Medicine, Seoul, South Korea


    J. Kim, None

    H. Pai, None

    M. R. Seo, None

    J. O. Kang, None

    T. Y. Choi, None

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