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Background: Viral infections can cause significant morbidity in cystic fibrosis (CF). The current Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic could therefore have a serious impact on the health of people with CF (pwCF). Methods: We used the 38-country European Cystic Fibrosis Society Patient Registry (ECFSPR) to collect case data about pwCF and SARS-CoV-2 infection. Results: Up to 30 June 2020, 16 countries reported 130 SARS-CoV-2 cases in people with CF, yielding an incidence of 2.70/10 0 0 pwCF. Incidence was higher in lung-transplanted patients (n = 23) versus non transplanted patients (n = 107) (8.43 versus 2.36 cases/10 0 0). Incidence was higher in pwCF versus the age-matched general population in the age groups < 15, 15-24, and 25-49 years (p < 0.001), with similar trends for pwCF with and without lung transplant. Compared to the general population, pwCF (regardless of transplantation status) had significantly higher rates of admission to hospital for all age groups with available data, and higher rates of intensive care, although not statistically significant. Most pwCF recovered (96.2%), however 5 died, of whom 3 were lung transplant recipients. The case fatality rate for pwCF (3.85%, 95% CI: 1.26-8.75) was non-significantly lower than that of the general population (7.46%; p = 0.133). Conclusions: SARS-CoV-2 infection can result in severe illness and death for pwCF, even for younger patients and especially for lung transplant recipients. PwCF should continue to shield from infection and should be prioritized for vaccination. (c) 2021 The Authors. Published by Elsevier B.V. on behalf of European Cystic Fibrosis Society. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Postantimikrobni proljev (PAP) je komplikacija povezana s primjenom antimikrobnih lijekova. Incidencija PAP je različita s obzirom na vrstu antimikrobnog lijeka i čimbenike rizika, a varira između 5–25%. Clostridium difficile (C. difficile) je najčešći uzročnik PAP. Cilj ovog istraživanja bio je istražiti epidemiološke i kliničke osobitosti postantimikrobnog proljeva i bolesti povezane s C. difficile u odraslih bolesnika liječenih u Klinici za infektivne bolesti "Dr. Fran Mihaljević" u Zagrebu. Retrospektivno su analizirane povijesti bolesti bolesnika hospitaliziranih od 1. siječnja 2012. do 31. lipnja 2013. godine. Od 217 bolesnika s PAP, C. difficile je dokazan u 161 (74%) bolesnika. Medijan dobi bolesnika iznosio je 72 godine (raspon 23–93 godine); 105 (48%) ih je bilo muškog spola. Barem jedan od čimbenika rizika imalo je 212 (98%) bolesnika od kojih su najčešći bili: starija životna dob (≥60 godina) u 164 (76%), hospitalizacija ≤30 dana prije pojave PAP u 153 (71%), prethodno imunosupresivno liječenje u 28 (13%). Antimikrobni lijekovi koji su najčešće bili povezani s nastankom PAP bili su: penicilini u 63 (29%), cefalosporini u 56 (26%), metronidazol u 40 (18%) te kinoloni u 38 (17%) bolesnika. Najčešći razlozi uzimanja antimikrobnog lijeka bili su: infekcija mokraćnog sustava u 65 (30%), infekcija dišnog sustava u 48 (22%) te gastrointestinalna infekcija u 25 (12%). Leukocitoza je pri prijmu zabilježena u 128 (80%) bolesnika; medijan broja leukocita iznosio je 13,3×109/L (raspon 4–71×109/L); medijan vrijednosti CRP iznosio je 66,9 mg/L (raspon 0,4–391 mg/L). Bolest je prosječno trajala 11 (raspon 1–67) dana. Većina naših ispitanika uspješno je izliječena uz stopu smrtnosti od 4%, a stopu recidiva od 7% tijekom 6-mjesečnog praćenja. U multiplom regresijskom modelu, trajanje bolesti do hospitalizacije te vrijednost CRP-a pokazali su se značajnim neovisnim prediktorima ukupnog trajanja i težine bolesti. Nije bilo statistički značajne razlike u najvažnijim demografskim, kliničkim i laboratorijskim značajkama bolesnika s etiološki dokazanim i nedokazanim PAP. Za sveobuhvatniji uvid u epidemiološke i kliničke osobitosti postantimikrobnog proljeva i bolesti povezane s C. difficile potrebno je u buduća istraživanja uključiti i ambulantno liječene bolesnike s blažim kliničkim oblicima bolesti., Antibiotic-associated diarrhea (AAD) is a complication related to the use of antibiotics. The incidence of AAD varies, depending on the type of antibiotic and risk factors, between 5–25%. Clostridium difficile (C. difficile) is the most common cause of AAD. The aim of the study was to determine epidemiological and clinical characteristics of AAD and Clostridium difficile-associated disease among adult patients hospitalized at the University Hospital for Infectious Diseases in Zagreb. Medical charts of patients hospitalized between January 1, 2012 and June 31, 2013 were retrospectively analyzed. Out of 217 patients with AAD, C. difficile was confirmed in 161 (74%) cases. Median age of patients was 72 years (range 23–93 years); 105 (48%) were male. At least one of the risk factors for development of AAD was present in 212 (98%) patients, with the most frequent being: older age (≥60 years) in 164 (76%), hospitalization in the past 30 days before onset of AAD in 153 (71%), previous immunosuppressive treatment in 28 (13%) patients. The most frequent antibiotics associated with AAD were: penicillins in 63 (29%), cephalosporins in 56 (26%), metronidazole in 40 (18%), and quinolones in 38 (17%) patients. The most frequent reasons for antibiotic treatment were: urinary tract infection in 65 (30%), respiratory tract infection in 48 (22%), and gastrointestinal infection in 25 (12%) cases. At admission, leukocytosis was registered in 128 (80%) patients; median WBC count was 13,3×109/L (range 4–71×109/L); median CRP was 66,9 mg/L (range 0,4–391 mg/L). Median disease duration was 11 (range 1–67) days. Most of our patients were successfully cured with mortality rate of 4%, and recurrence rate of 7% during the 6-month follow-up period. Multiple regression model showed that both, duration of symptoms prior to hospitalization and CRP level at admission, were significant independent predictors of duration and outcome of the disease. There were no statistically significant differences in most relevant demographic, clinical and laboratory parameters among patients with and without confirmation of C. difficile. For the overall epidemiological and clinical conclusions related to antibiotic-associated diarrhea and Clostridium difficile-associated disease, patients with less severe diseases and ambulatory treatment should be included in future studies, too.