| Abstract | UVOD: Incidencija i značaj infekcije uzrokovane s Clostridioides difficile (CDI) u porastu su diljem svijeta. Za razliku od bolesnika starije životne dobi, epidemiološka i klinička obilježja CDI u radnoaktivnoj populaciji slabije su istražena. ----- CILJ: Utvrditi i usporediti stope rekurencije CDI među bolesnicima dobi 30-64 godine i onih ≥ 65 godina te usporediti epidemiološke i kliničke osobitosti rekurentnih CDI među navedenim dobnim skupinama. Također, cilj je i identificirati čimbenike rizika za rekurenciju CDI među bolesnicima dobi 30-64 godina i usporediti njihove stope rekurencije ovisno o epidemiološkim okolnostima razbolijevanja tijekom prve CDI epizode. ----- ISPITANICI I METODE: Retrospektivno, deskriptivno istraživanje provedeno na bolesnicima dobi 30-64 godine hospitalno liječenih zbog laboratorijski potvrđene CDI u razdoblju od godine 2013.-2019. u Klinici za infektivne bolesti „Dr. Fran Mihaljević“. ----- REZULTATI: U ukupnom uzorku hospitalizacije bolesnika s CDI dobi 30-64 godine činile su 16,36% (297/1816 hospitalizacija). Među njima bilo je 70,95% hospitalizacija zbog CDI povezanih sa zdravstvenom skrbi (CDI PZS), 21,28% zbog izvanbolnički stečenih CDI (CDI IB), a kod 7,77% epidemiološke okolnosti razbolijevanja nisu se mogle utvrditi. U promatranom razdoblju udio hospitalizacija bolesnika dobi 30-64 godine s CDI se u ukupnom uzorku kretao u rasponu od 33,00% do 12,62% te je u promatranom razdoblju značajno padao (p = 0,032). Udio bolesnika hospitaliziranih zbog rekurentnih CDI među bolesnicima dobi 30-64 godine i ≥ 65 godina nije se značajno razlikovao (32,6 vs. 38,0%) (p = 0,255). Među bolesnicima dobi 30-64 godine s CDI nije bilo značajne razlike među udjelima bolesnika s rekurentnim CDI s obzirom na promatrane epidemiološke okolnosti razbolijevanja tijekom prve epizode CDI (CDI PZS vs. CDI IB: 23,46 vs. 16,39%). Multivarijantnom analizom nisu pronađeni prediktori za rekurenciju CDI kod bolesnika dobi 30-64 godine. Bolesnici s rekurentnom CDI dobi 30-64 godine su u usporedbi sa bolesnicima dobi ≥ 65 godina imali značajno niži broj leukocita u perifernoj krvi, višu razinu serumskih albumina i nižu razinu serumskog kreatinina (p < 0,05). Stopa smrti je u bolesnika s rekurentnim CDI bila značajno niža u bolesnika dobi 30-64 godine u odnosu na bolesnike ≥ 65 godina (2,06 vs. 8.35%) (p = 0,033), dok se navedene grupe nisu razlikovale prema potrebi liječenja u jedinici intenzivnog liječenja kao niti prema dužini hospitalizacije (p > 0,05). ----- ZAKLJUČAK: Među hospitalno liječenim bolesnicima s CDI nije nađena značajna razlika u udjelu bolesnika s rekurentnim CDI pri usporedbi bolesnika dobi 30-64 godine i ≥ 65 godina. Bolesnici dobi 30-64 godine s rekurentnim CDI imaju značajno nižu stopu smrti u usporedbi s bolesnicima dobi 65 godina, dok se po potrebi liječenja u JIL-u i dužini hospitalizacije nisu značajno razlikovali. Među bolesnicima dobi 30-64 godine s CDI nema značajne razlike među udjelima bolesnika s rekurentnim CDI s obzirom na promatrane epidemiološke okolnosti razbolijevanja tijekom prve epizode CDI. |
| Abstract (english) | BACKGROUND: Incidence and importance of infection caused by Clostridioides difficile (CDI) are increasing worldwide. In contrast to elderly patients, the epidemiological and clinical features of CDI in working population are poorly studied. ----- OBJECTIVE: To identify and compare CDI recurrence rates among patients aged 30-64 and those ≥ 65 years and compare the epidemiological and clinical characteristics of recurrent CDIs among these age groups. Another aim is to identify risk factors for CDI recurrence among patients aged 30-64 and compare their recurrence rates depending on the CDI case origin during the first CDI episode. ----- PARTICIPANTS AND METHODS: A retrospective descriptive study conducted on patients aged 30-64 years who were hospitalized for laboratory-confirmed CDI from 2013 to 2019 at the University Hospital for Infectious Diseases "Dr. Fran Mihaljević“. ----- RESULTS: Of the total sample of hospitalizations due to CDI, patients aged 30-64 years accounted for 16,36% (297/1816). Among them, 70,95% had healthcare-associated CDI, 21,28% had community-acquired CDI, and in 7,77% the CDI case origin could not be determined. In the observed period, the proportion of hospitalizations of patients with CDI aged 30-64 years of the total sample ranged from 33,00% to 12,62% and followed a statistically significant negative trend (p = 0,032). The proportion of patients hospitalized for recurrent CDI among patients aged 30-64 years and ≥ 65 years did not differ significantly (32,6 vs. 38,0%) (p = 0,255). Among patients with CDI aged 30-64 years, there was no significant difference between the proportions of patients with recurrent CDI depending on the CDI case origin during the first CDI episode (HA-CDI vs. CA-CDI: 23,46 vs. 16,39%). Multivariant analysis found no predictors for CDI recurrence in patients aged 30-64 years. Patients with recurrent CDI aged 30-64 years had significantly lower leukocyte counts in peripheral blood compared to patients aged ≥ 65 years, higher serum albumin levels and lower serum creatinine levels (p < 0,05). The death rate was significantly lower in patients with recurrent CDI aged 30-64 years compared to patients ≥ 65 years (2,06 vs. 8,35%) (p = 0,033), while these groups did not differ according to the treatment in ICU or the length of hospitalization (p > 0,05). ----- CONCLUSIONS: No significant difference was found in the proportion of patients with recurrent CDI among all hospitalized patients with CDI when comparing patients aged 30-64 years and ≥ 65 years. Patients with recurrent CDI aged 30-64 years had a significantly lower death rate compared to patients aged 65 years, while the need for ICU treatment and length of hospitalization did not differ significantly. Among patients with CDI aged 30-64 years, there is no significant difference between the proportions of patients with recurrent CDI depending on the CDI case origin during the first CDI episode. |
