RISK FACTORS IN HEALTHCARE-ASSOCIATED CLOSTRIDIOIDES DIFFICILE INFECTION.

Background: Clostridiodes Difficile, a toxigenic anaerobic bacterium, is an infectious pathogen often associated with severe infectious colitis that causes significant morbidity and mortality globally, especially in the elder patients. Also, Clostridioides Difficile represents one of the main agents that can cause health-care associated infections, making this specifical type of disease a public health issue, requiring a multifaceted approach, including spread control, mindful usage of antibiotics, patient education, also requiring future research to develop more effective treatments and prevention strategies. Material and methods: A retrospective study was carried over a period of 4 years (2020-2023), in which there were included 232 patients hospitalized in the Internal Medicine Clinic of the Emergency County Clinical Hospital of Târgu Mureş.Inclusion criteria consisted of bacteriological confirmed diagnosis of Clostridioides difficile enterocolitis, treated in the clinic, with some of further being transferred to a Infectious Diseases Clinic. Data collection was made by reviewing existing documentation in all discharge notes and clinical observation sheets from admissions and consultations of patients with Clostridioides difficile enterocolitis. Results: With a cohort of 232 patients, aged between 26 and 96 years, analysis revealed that the infection is more common in the elder population, with an average age of affected patients being around 73 years old. Most patients developed the infection during hospitalization. Intravenous antibiotic treatment was strongly associated (87%cases). Another result highlighted is that the use of broad- spectrum antibiotic therapy represents the main risk factor for the development of this condition. Combined pharmacotheraphy was common, with more than half of patients(52%) receiving two or more different classes of antibiotics,particularly cephalosporins. The analysis of the association between the antibiotic therapy combination and the patient's survival rate revealed that cases of death most often occured when the patient received a combination of antibiotics (23%), compared to monotheraphy in those who survived (30%). The analysis of the duration of antibiotic treatment revealed that the deceased individuals received treatment for a longer period. Another noteworthy aspect is that one-fifth of the patients had undergone surgical intervention prior to developing the infection, and a history of pseudomembranous colitis was a significant predictor for the recurrence of the infection (p< 0.05). The mortality rate following Clostridioides difficile infection was 33%, with a positive correlation between the duration of broad-spectrum antibiotic treatment and mortality (p< 0.05). These findings emphasize the relevance of appropriate management of antibiotic therapy and associated pathologies in the prevention and treatment of Clostridioides difficile infection. Conclusions: This study has examined the dynamics and risk factors of Clostridioides difficile infection among a cohort of patients hospitalized in the Internal Medicine department. Most patients originate in rural areas, as low income and socioeconomic status play an important role in the occurence of this infection. Beyond demographic characteristics, the use of broad-spectrum antibiotics was identified as a major risk factor, involved in over 80% of cases. This paper aims to highlight the risk factors associated with Clostridium Difficile, while presenting valuable corelations with the particularities of the affected patients. [ABSTRACT FROM AUTHOR]