Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: Findings from the nationwide FADOI-PRACTICE study

Giorgio Cioni, Pierluigi Viale, Stefania Frasson, Francesco Cipollini, Francesco Menichetti, Nicola Petrosillo, Sergio Brunati, Patrizia Spigaglia, Chiara Vismara, Alessandra Bielli, Fabrizio Barbanti, Giancarlo Landini, Grazia Panigada, Gualberto Gussoni, Erminio Bonizzoni, Giovanni Pietro Gesu, A. Costantino, R. Masciari, G. Amato, A. FontanellaF. Gallucci, L. Improta, M. R. Poggiano, P. G. Rabitti, G. Uomo, Giuseppe Civardi, M. Confalonieri, M. Grandi, C. Sacchetti, T. Baldini, G. Cioni, S. Miglioli, M. Sarti, M. P. Landini, Domenico Panuccio, Elisabetta Romboli, C. Vocale, F. Berti, L. Bonito, M. L. Gozzo, D. Manfellotto, S. Natili, R. Pastorelli, F. Colombo, G. Lombardi, A. Mazzone, M. Romano, A. D'Angelo, G. Rossolini, G. Battaglia, for the Research Department of FADOI

Research output: Contribution to journalArticlepeer-review


Background: Clostridium difficile (CD) is a leading cause of diarrhoea among hospitalized patients. The objective of this study was to evaluate the rate, the optimal diagnostic work-up, and outcome of CD infections (CDI) in Internal Medicine (IM) wards in Italy. Methods: PRACTICE is an observational prospective study, involving 40 IM Units and evaluating all consecutive patients hospitalized during a 4-month period. CDI were defined in case of diarrhoea when both enzyme immunoassay for GDH, and test for A/B toxin were positive. Patients with CDI were followed-up for recurrences for 4 weeks after the end of therapy. Results: Among the 10,780 patients observed, 103 (0.96 %) showed CDI, at admission or during hospitalization. A positive history for CD, antibiotics in the previous 4 weeks, recent hospitalization, female gender and age were significantly associated with CDI (multivariable analysis). In-hospital mortality was 16.5 % in CD group vs 6.7 % in No-CD group (p < 0.001), whereas median length of hospital stay was 16 (IQR = 13) vs 8 (IQR = 8) days (p < 0.001) among patients with or without CDI, respectively. Rate of CD recurrences was 14.6 %. As a post-hoc evaluation, 23 out of 34 GDH+/Tox- samples were toxin positive, when analysed by molecular method (a real-time PCR assay). The overall CD incidence rate was 5.3/10,000 patient-days. Conclusions: Our results confirm the severity of CDI in medical wards, showing high in-hospital mortality, prolonged hospitalization and frequent short-term recurrences. Further, our survey supports a 2-3 step algorithm for CD diagnosis: EIA for detecting GDH, A and B toxin, followed by a molecular method in case of toxin-negative samples.

Original languageEnglish
Article number656
JournalBMC Infectious Diseases
Issue number1
Publication statusPublished - Nov 8 2016


  • Clostridium difficile
  • Incidence
  • Internal Medicine
  • Outcome
  • Predictors

ASJC Scopus subject areas

  • Infectious Diseases


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