The epidemiological and clinical study of patients with clostridium difficile enterocolitis in Varna, Bulgaria

Introduction. Clostridium difficile infections (CDI) remain a global health concern. Currently, no unified approach to the diagnostics and determining severity of these infections despite their high urgency throughout the world was proposed. The aim of the study is to identify risk factors for CDI, investigate clinical and epidemiological features of the disease course and potential for using the ATLAS scale to assess its severity. Materials and methods. 36 CDI patients hospitalized at the Infectious Disease Clinic of Varna were analyzed during the period from January 2018 until June 2019. Clinical and epidemiologic study was conducted. The diagnosis was made by using a rapid immunochromatographic test; CDI patient stratification was performed by ATLAS scoring system. Results and discussion. Within the aforementioned period, 1100 patients were hospitalized at the Infectious Disease Clinic of Varna, and CDIs were reported in 3,3% of cases. The most affected were elderly individuals (the mean age was 69,8±16,4 years old) most of whom were females (92%) with only 6% of males. The following risk factors were investigated: comorbidities — 32 patients (88,89%), recent hospitalization — 19 patients (52,78%), antibiotic use — 31 patients (86,11%). Twenty-four patients (66,67%, ATLAS score ≤ 4 points) had mild CDI, whereas moderate form of CDI was observed in 12 patients (33,33%). No severe CDI or death were observed. The characteristic clinical presentation included fever, diarrhea and abdominal cramping. The treatment was implemented according to the national and international recommendations by using oral Metronidazole for 11 patients (30,56%), Vancomycin — for 12 patients (33,33%), or both — for 13 patients (36,11%). Conclusion. Patients at risk with symptoms of enterocolitis and a history of antibiotic use or hospitalizations should be screened for the presence of toxin-forming strains of Clostridium difficile. According to the European Centre for Disease Prevention (ECDC) the diagnostic yield of CDI may be increased by using two-step protocol, whereas the ATLAS score system may be a useful tool for routine evaluation of patients with CDI.