Objectives

Clostridioides difficile infection (CDI) represents a challenging issue, with an evolving epidemiology. Main objectives of our study were: to assess the frequency of diarrhea of overall etiology, including CDI, as a cause of hospital admission or occurring during hospital stay;- to determine the rate of underdiagnosis of community-acquired (CA-), health care associated (HCA)- and hospital onset (HO-) CDI, and explore factors associated with its clinical suspicion by physicians.

Methods

A prospective cohort study included all hospitalized patients with diarrhea at two acute-care hospitals. C. difficile (CD) tests were performed on every stool samples, irrespective of the treating physician request. Factors associated with the likelihood of CD test request by physicians were assessed.

Results

We enrolled 871 (6%) patients with diarrhea. CD test performed on all diarrheic stool samples was positive in 228 cases (26%); 37, 106, 85 cases of CA- (14%), HCA- (42%) and HO- diarrhea (24%), respectively. Treating physicians did not request CD test in 207 (24%) diarrhea cases. The rate of CDI underdiagnosis was 11% (24/228); it was higher in CA-CDI (27%, 10/37). Logistic regression analysis identified age >65 years (RR 1.1; 95 CI 1.06–1.2) and hospitalizations in the previous 3 months (RR 1.2; 95% CI 1.1–1.3) as independent factors associated with the likelihood of requesting the CD test by the physician. These risk factors differed by epidemiological classification of diarrhea and by hospital.

Conclusions

Our study confirmed the relevance of CDI underdiagnosis and provided new insights in the factors underlying the lack of CDI clinical suspicion.

中文翻译：

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腹泻住院患者：难辨梭菌感染率和临床怀疑的驱动因素

目标

艰难梭菌感染 (CDI) 是一个具有挑战性的问题，流行病学不断发展。我们研究的主要目标是：评估作为住院或住院期间发生的整体病因（包括 CDI）腹泻的频率；- 确定社区获得性 (CA-)、医疗保健的漏诊率相关 (HCA)- 和医院发病 (HO-) CDI，并探讨与医生临床怀疑相关的因素。

方法

一项前瞻性队列研究包括在两家急诊医院住院的所有腹泻患者。无论主治医师的要求如何，都对每个粪便样本进行了艰难梭菌(CD) 测试。评估了与医生要求 CD 测试的可能性相关的因素。

结果

我们招募了 871 (6%) 名腹泻患者。228 例 (26%) 对所有腹泻粪便样本进行 CD 检测呈阳性；分别有 37、106、85 例 CA- (14%)、HCA- (42%) 和 HO- 腹泻 (24%)。在 207 (24%) 例腹泻病例中，主治医师未要求进行 CD 检测。CDI 漏诊率为 11% (24/228)；CA-CDI 更高（27%，10/37）。Logistic 回归分析将年龄 >65 岁（RR 1.1；95 CI 1.06-1.2）和前 3 个月的住院（RR 1.2；95% CI 1.1-1.3）确定为与要求 CD 检测的可能性相关的独立因素医生。这些危险因素因腹泻的流行病学分类和医院而异。

结论

我们的研究证实了 CDI 诊断不足的相关性，并为缺乏 CDI 临床怀疑的潜在因素提供了新的见解。