Analysis of cases of antibiotic-associated diarrhea caused by Clostridium difficile in patients of an infectious diseases hospital

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Abstract

BACKGROUND: Over the past 20 years, the global incidence of infection caused by Clostridium difficile has increased almost fourfold. Widespread and uncontrolled use of antibiotics has resulted in clostridial infection becoming one of the most dangerous healthcare-associated infections, with mortality increasing at an alarming rate.

AIM: This work aimed to determine changes in the proportion of clostridial infection within the distribution of acute intestinal infections, to analyze risk factors contributing to disease development, and to assess the association between disease severity, major clinical manifestations, and outcomes in patients of an infectious diseases hospital.

METHODS: Statistical data on all cases of acute intestinal infections registered at the S.P. Botkin Clinical Infectious Diseases Hospital from 2019 to 2024 were analyzed. In addition, a retrospective review of medical records of patients hospitalized in this institution from January to April 2025 with a confirmed diagnosis of A04.7 Enterocolitis due to Clostridium difficile according to the International Classification of Diseases, Tenth Revision (ICD-10) was performed.

RESULTS: A substantial increase in the proportion of clostridial infection within the overall distribution of acute intestinal infections from 2019 to 2024 was identified in Saint Petersburg and the Leningrad Region. Clostridium difficile infection was associated with advanced age, hospital readmission within 3 months after discharge, antibiotic therapy, presence of comorbidities—primarily cardiovascular diseases—gastrointestinal disorders, type 2 diabetes mellitus, postoperative conditions, and chronic kidney and liver diseases. In addition, a direct association was established between the severity of clinical manifestations, overall disease severity, and infection-related mortality.

CONCLUSION: Given the widespread increase in cases of clostridial infection in recent years, it is necessary not only to strengthen infection control measures in hospitals and other healthcare institutions but also to implement educational programs in outpatient and primary care settings to improve medical staff awareness of Clostridium difficile infection.

About the authors

Margarita V. Klur

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: Margarita.Кlur@szgmu.ru
ORCID iD: 0009-0006-6222-2452
SPIN-code: 8911-6769

MD, Сand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg

Nickolay R. Davtyan

North-Western State Medical University named after I.I. Mechnikov

Email: davtyannickolay@mail.ru
ORCID iD: 0009-0003-5272-3470
SPIN-code: 6090-5228

MD

Russian Federation, Saint Petersburg

Margarita N. Pogromskaya

North-Western State Medical University named after I.I. Mechnikov; S.P. Botkin Clinical Infectious Diseases Hospital

Email: margopogr@yandex.ru
ORCID iD: 0000-0001-8072-6589
SPIN-code: 6035-8449

MD, Сand. Sci. (Medicine), Assistant Professor

Russian Federation, Saint Petersburg; Saint Petersburg

Olga Yu. Osinovets

North-Western State Medical University named after I.I. Mechnikov

Email: emelianova_inf@mail.ru
ORCID iD: 0009-0004-7938-1121
SPIN-code: 7178-1292

MD, Сand. Sci. (Medicine)

Russian Federation, Saint Petersburg

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