Extraintestinal manifestations in inflammatory bowel disease ; the prevalence in tertiary referral center

Background: CDI is the main cause of antibiotic associated infectious diarrhea. Incidence, severity and burden on the healthcare system related to CDI have increased in last decade in many industrialized countries. Epidemiological data of CDI are scarce in Southern Europe. Aims: To evaluate incidence and secular trend of nosocomial CDI between 2000 and 2009 in two Spanish referral hospitals. To analyze the highest incidence rates across specialties. Methods: Setting: Two referral hospitals in the Barcelona metropolitan area. Design: Retrospective surveillance study. Laboratory CDI diagnosis: Positive toxigenic culture and/or toxin detection in fecal samples using cell citoxicity neutralization assay. Patients: All in-patients from whom an appropriate fecal sample was submitted for CDI study between January 2000 and December 2009 were included. Nosocomial CDI case definition: A nosocomial CDI case was defined by the presence of either a positive stool test for C. difficile toxin or toxigenic C. difficile more than 48 hours after admission and that not have been diagnosed of CDI within the previous 28 days. Results: We identified 278 cases. Between 2000 and 2005 CDI incidence remained stable (0.52 and 0.54 cases/10.000 inpatient days in 2000 and 2005 respectively). During second half of this decade a four fold increase in incidence occurred (0.79, 1.48, 1.95 y 2.33 cases/10.000 in-patient days in 2006, 2007, 2008 y 2009 respectively). During de same period there was an increased hospitalary antibiotics consumption (from 56 to 67 defined daily doses/100 in-patient days between 2000 and 2009) that correlated with nosocomial CDI incidence (r = 0.98, p < 0.001). Hematology, ICU, Infectious Diseases and Gastroenterology Departments had the highest CDI incidence rates. Conclusions: CDI incidence has quadruplicate during second half of last decade coinciding with an increased use of antibiotics. Our results highlight the importance of CDI surveillance in hospitals, specially among high risk departments.