Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case-control study

Background: The objective of this study was to investigate independent risk factors (RFs) connected with healthcare-associated (HA) Clostridium difficile infection (CDI) in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital. Methods: Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI. Results: The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93-58.4), the admission to intensive care unit (P = 0.004, OR: 3.00, 95% CI: 1.41-6.40), and the administration of 3rd generation cephalosporins (P = 0.014, OR: 2.27, 95% CI: 1.18-4.39). Patients with HA CDI had significantly higher in-hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84-43.43). Conclusions: CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.