Clostridioides difficile infection: Incidence and risk factors in a tertiary care facility in Riyadh, Saudi Arabia

• Published in: Journal of infection and public health 2020-07, Vol.13 (7), p.1012-1017
• Main Authors: Alzouby, Sally, Baig, Kamran, Alrabiah, Fahad, Shibl, Atef, Al-Nakhli, Daifallah, Senok, Abiola C.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Clostridioides difficile; Clostridioides difficile - isolation & purification; Clostridium Infections - drug therapy; Clostridium Infections - epidemiology; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Diarrhea - epidemiology; Diarrhea - microbiology; Epidemiology; Female; Humans; Incidence; Infection control; Male; Prospective Studies; Risk Factors; Saudi Arabia; Saudi Arabia - epidemiology; Tertiary Care Centers
• ISSN: 1876-0341; 1876-035X
• DOI: 10.1016/j.jiph.2019.10.014

Significant increase in rates of Clostridioides difficile associated diarrhea (CDI) has been reported globally but there remains a paucity of data from Saudi Arabia. Prospective hospital-based surveillance for CDI using the Center for Disease Control (CDC) criteria was conducted from June to November 2015 in a tertiary healthcare facility in Riyadh, Saudi Arabia. During the surveillance period, 106 episodes of CDI were identified among 59 patients in 137,230 patient-days. The incidence of CDI was 3.5 per 10,000 patient days. Of the 106 episodes, 58% (n=61) were new cases, 12% (n=13) were recurrent cases and 30% (n=32) were duplicate cases. Majority of the new cases (n/N=43/61; 70%) were healthcare onset, followed by community onset (21%) and 8% were community-onset healthcare associated. No statistically significant change in trend was observed during the surveillance period. The most prevalent CDI risk factor was use of proton pump inhibitor (PPI) (92%) followed by prolonged use of antibiotics (77%). Pareto-analysis indicated that controlling for PPI use, prolong and multiple antibiotic exposure and prolonged hospitalization results in 80% CDI reduction. The findings indicate a low incidence of CDI. Multicenter studies are needed to elucidate the burden to CDI in the country.