|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||Studio prospettico sull'infezione da Clostridium difficile in un ospedale terziario del nord Italia|
|Titolo in inglese||Prospective study of Clostridium difficile infection in a tertiary-care hospital in northern Italy|
|Struttura||Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze|
|Corso di studi||MEDICINA E CHIRURGIA (D.M.270/04)|
|Data inizio appello||2018-07-18|
|Disponibilità||Accessibile via web (tutti i file della tesi sono accessibili)|
BACKGROUND Clostridium difficile infection (CDI) is the most common infectious, antibiotic-associated diarrhea. It is a growing health care problem, poorly controlled in many European countries, especially in Italy, where a national CDI surveillance is lacking. European data on CDI epidemiology in acute healthcare setting are limited and significantly different from country to country. In 2015 the European Center for Disease Control (ECDC) proposed a nosocomial-CDI surveillance system. The aim of the study is to investigate the impact of this multifaceted surveillance system on the incidence of hospital-acquired CDI. METHODS Between October 2014 and October 2016 we conducted a prospective study on CDI in Azienda Ospedaliero-Universitaria Policlinico Modena (AOUPM), a tertiary care University Teaching Hospital in North Italy. At the beginning of 2015 according to 2015 ECDC protocol for hospital-based CDI surveillance we elaborated a specific intervention protocol including: prospective collection of CDI cases in a database with all the data enabling to discriminate between colonizations and infections; audit of CDI cases, educational training about CDI. Primary outcome was CDI incidence variation during the study period. Secondary outcomes were to investigate epidemiological, microbiological, clinical characteristics and risk factors both for primary and for recurrent CDI cases. RESULTS CDI incidence increased from 9.39/10000 patient-days at the beginning of 2014 to 20.8/10000 patient-days at the beginning of 2015. After the targeted intervention, it decreased dramatically to 8.3/10000 patient-days in the second half of 2015, and to 5.3/10000 patient-days in the first six months of 2016 (Figure 1) (pre-post intervention comparison p=0.003). Quinolones and 3rd generation cephalosporin defined daily doses (DDDs)/1,000 patient-days decreased from 22 in 2014 to 13 in the first 6 months of 2016 and from 7.8 in 2014 to 3 in the first 6 months of 2016 respectively. CONCLUSIONS Our study underlines that in settings of endemic CDI, it is essential to elaborate a targeted intervention to reduce hospital-acquired CDI, besides general infection control strategies. Implementing a standardized prospective active surveillance is the first line component to plan a successful prevention strategy.