The Recent Emergence of Clostridium difficile Infection in Romanian Hospitals is Associated with a High Prevalence of Polymerase Chain Reaction Ribotype 027

Abstract

Aims: To investigate the epidemiology of Clostridium difficileinfection in Romanian hospitals.Methods: A survey was conducted at nine hospitals throughoutRomania between November 2013 and February 2014.Results: The survey identified 393 patients with Clostridium difficileinfection. The median age was 67 years (range: 2-94 years); 56% ofpatients were aged >65 years. The mean prevalence of Clostridiumdifficile infection was 5.2 cases per 10.000 patient-days. The highestprevalences were 24.9 and 20 per 10.000 patient-days in hospitalsspecializing in gastroenterology and infectious diseases, respectively.Clostridium difficile infections were health care-associated in 70.5%patients and community-acquired in 10.2%. The origin was notdetermined in 19.3%. Clostridium difficile infection was severe in12.3% of patients, and the in-hospital all-cause mortality was 8.8%.Polymerase chain reaction ribotype 027 had the highest prevalence inall participating hospitals and represented 82.6% of the total ribotypedisolates. The minimum inhibitory concentration of moxifloxacin was>4 μg/mL for 59 of 80 tested isolates (73.8%). Of 59 isolates, 54 werehighly resistant to moxifloxacin (minimum inhibitory concentration≥32 μg/mL), and the majority were polymerase chain reactionribotype 027 (p