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Clostridium difficile sýkingar á Landspítala 1998-2008

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Authors
Rúnar Bragi Kvaran
Elsa Björk Valsdóttir
Helgi Kjartan Sigurðsson
Magnús Gottfreðsson
Issue Date
2010-09-01

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Other Titles
Clostridium difficile infections at Landspítali - 1998-2008
Citation
Læknablaðið 2010, 96(9):523-9
Abstract
OBJECTIVE: To study the epidemiology and severity of C. difficile infections (CDI) at Landspítali over 11 year period, 1998-2008. MATERIAL AND METHODS: CDI were identified by a positive toxin assay in stools from the database of the Department of Microbiology. Chart review was conducted on patients diagnosed in January and June each year during the study period, a total of 237 infections. RESULTS: Overall, 1,861 of 11,968 submitted stool samples were positive for C. difficile toxin, representing 1,492 infections. The population-based incidence was 29% higher in the end than in the beginning of the period and was highest in the age group >80 years where it was 387 cases per 100,000 person-years. The incidence per 1,000 admissions and 10,000 hospital days increased by 71% and 102%, respectively. 47% of the infections were nosocomial. Most patients had history of antibiotic exposure prior to the infection and the most common symptom was diarrhea. Response to a single antibiotics course was good (93%). No patient required surgery due to colitis. CONCLUSION: The incidence of CDI was higher in 2008 than 11 years before. Most patients had well characterized risk factors for CDI. For most patients a single course of metronidazole treatment resolved the infection. Based on these data, the severity of CDI does not seem to be increasing in Iceland.
Tilgangur: Að kanna faraldsfræði og alvarleika ristilbólgu af völdum C. difficile á Landspítala og meta hvort meinvirkni sýkingarinnar hafi aukist á Íslandi líkt og víða á Vesturlöndum. Efniviður og aðferðir: Sýkingar af völdum C. difficile á Landspítala árin 1998-2008 voru fundnar með því að finna jákvæð eiturefnapróf í hægðasýnum úr gagnagrunni sýklafræðideildar. Úrtak klínískra upplýsinga um sjúklinga sem voru greindir í janúar og júní hvert ár á rannsóknartímabilinu var skoðað sérstaklega. Alls voru það 237 sýkingar. Niðurstöður: Á 11 ára tímabili reyndist 1861 sýni af 11.968 (16%) jákvætt fyrir C. difficile og einstakar sýkingar voru 1492. Nýgengi sýkingar var 29% hærra í lok en upphafi tímabilsins og var að meðaltali hæst í aldurshópnum >80 ára þar sem það var 387 tilfelli á hverja 100.000 íbúa Íslands á ári. Fjöldi sýkinga á 1000 innlagnir jókst um 71% og fjöldi sýkinga á 10.000 legudaga jókst um 102%. 92% sýkinga tengdust heilbrigðisþjónustu og 47% voru spítalasýkingar. Meirihluti sjúklinga tók sýklalyf innan þriggja mánaða fyrir sýkingu. Algengasta einkenni sýkingar var niðurgangur. Yfirgnæfandi meirihluti (93%) þeirra sem nægar upplýsingar fundust um náðu bata eftir eina sýklalyfjameðferð og enginn gekkst undir aðgerð. Ályktanir: Sýkingar af völdum C. difficile voru fleiri árið 2008 á Landspítala en árið 1998. Innsendum sýnum fjölgaði hins vegar stöðugt og meira en sýkingum. Fáir sýkjast án þess að hafa einn eða fleiri þekktra áhættuþátta. Í flestum tilvikum dugði stök meðferð með metrónídazóli til þess að uppræta sýkingu. Meinvirkni C. difficile virðist ekki hafa aukist hér á landi.
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