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Bertolino L, Patauner F, Gagliardi M, D'Amico F, Crivaro V, Bernardo M, Scherillo I, Bellitti F, Cusano C, Greco R, Panetta V, Durante A, Di Caterino A, Frieri A, Cioffi G, Nappo M, Corrado M, Lanzieri M, Sabatini P, Bettelli R, Dello Russo R, Taddeo ML, Petrone R, Di Sevo MG, Iannuzzo M, Iervolino M, Buonocore R, D'Agostino F, Gambardella M, De Martino A, Spagnuolo S, Savarese M, Sole S, Russo C, Agozzino E, Galdiero M, Martino R, Calemma R, Sciambra A, Aprea C, Colaccio D, Di Guida P, Venditti M, Montella E, Guerriero F, Perrotta R, Di Filippo U, Pizza A, Di Fronzo A, Lombardi A, Capuano L, De Stefano A, Mastropietro A, Mastro M, Loffreda R, Maccarone L, Di Tora A, Oto S, Tammaro C, Mondelli AC, Ruocco M, Ferraro B, Petrosino A, Presta SSA, Durante Mangoni E. Diagnostic and infection control strategies for Clostridioides difficile infections in a setting of high antimicrobial resistance prevalence. Infez Med 2021; 29:70-78. [PMID: 33664175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Clostridioides difficile (CD) is a major nosocomial pathogen and the leading cause of antibiotic-associated diarrhoea. In light of the strong association between antimicrobial use and CD infections (CDI), it may be hypothesised that areas at higher prevalence of antimicrobial resistance, like the region of Campania in southern Italy, could also have a higher rate of CDI. In this multicentre, region-based, prospective study, we analysed such issues, exploiting CDI incidence data collected from local hospitals. In 2016, the Italian National Centre for Disease Control supported a project involving three Italian regions: Friuli Venezia Giulia, Lazio and Campania. In Campania, a network of 49 hospitals willing to participate in the project was created. The project consisted of two phases: a survey on practice patterns concerning CDI and an epidemiological surveillance study. We identified a stringent need to improve awareness about CDI among the regional health-care community, as a widespread lack of surveillance programmes for CDI control was observed (existing in only 40% of participating facilities). Moreover, almost half of the participating hospitals (n=16, 43%) had no standardised procedures or protocols to control and prevent CDI. In the second phase of the study, we collected data of CDI cases during a six-month surveillance programme. In all, 87 CDI cases were observed, for a total of 903,334 patient bed-days and 122,988 admissions. According to the above data, CDI incidence was 0.96 cases/10000 patient bed-days, much lower than expected based on prior studies conducted elsewhere. The results of our study suggest CDI remains a rather neglected clinical issue in Campania. Despite a high burden of antimicrobial resistance and antimicrobial use in our geographic setting, we observed a very low incidence of CDI. Such a low incidence could be explained by underdiagnosis, but could also be related to actual diet, the lower patient age or the specific genetic background. However, further studies are warranted to either confirm or rebut the above hypotheses.
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Affiliation(s)
- Lorenzo Bertolino
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Massimo Gagliardi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fabiana D'Amico
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | | | | | | | | | | | - Rita Greco
- A.O.U. "Sant'Anna e San Sebastiano", Caserta, Italy
| | | | | | | | - Angelo Frieri
- "Sant'Angelo dei Lombardi" Hospital, Avellino, Italy
| | - Grazia Cioffi
- A.O.U.S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria Nappo
- A.O.U.S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Mariano Corrado
- "Umberto I" Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy
| | - Michele Lanzieri
- "Umberto I" Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy
| | - Paola Sabatini
- "Umberto I" Hospital, Nocera, and DEA Nocera-Pagani-Scafati, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erminia Agozzino
- Dipartimento di Medicina Sperimentale, Università della Campania "L. Vanvitelli", AOU della Campania "L. Vanvitelli", Naples, Italy
| | - Massimiliano Galdiero
- Dipartimento di Medicina Sperimentale, Università della Campania "L. Vanvitelli", AOU della Campania "L. Vanvitelli", Naples, Italy
| | - Rosa Martino
- Istituto NazionaleTumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Rosa Calemma
- Istituto NazionaleTumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | | | | | - Diego Colaccio
- "S. Giuseppe Melorio" Hospital, S. Maria Capua Vetere, Italy
| | | | | | | | | | | | | | | | | | - Anna Lombardi
- "S. Giovanni di Dio" Hospital, Frattamaggiore, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Emanuele Durante Mangoni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy; Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli - Monaldi Hospital, Naples, Italy
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