Epidemiology, recurrence, and mortality in patients with Clostridioides difficile : a nationwide surveillance study (2016–2022)

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BACKGROUND: Clostridioides difficile infection (CDI) is a significant contributor to healthcare-associated infections worldwide, with an increasing incidence in Europe. It has significant morbidity in high-risk, hospitalized patients. Despite previous studies in Spain, there have been no updates to nationwide data since 2015. AIM: To provide an updated epidemiological overview of CDI in Spain, focusing on incidence, recurrence, mortality, and regional variability in hospitalized patients between 2016 and 2022. METHODS: A nationwide, retrospective study was carried out using a Spanish national health system registry including data from hospitalization discharge reports. Data from 66,864 hospitalizations with a CDI diagnosis were analyzed and descriptive analyses and Poisson regression models were performed to assess trends in CDI incidence, recurrence, and mortality over time. RESULTS: CDI incidence increased from 30 to 43 cases per 100,000 hospitalizations between 2016 and 2022. Recurrence was observed in 15-16% of cases from 2020 to 2022. All-cause, in-hospital mortality remained steady at 11-13% over the observation period. There was regional variability, with some regions showing the highest incidences and other regions having the lowest. The median age of patients was 75 years, and women accounted for 53% of cases. CONCLUSION: The results highlight a steady increase in CDI incidence in Spain over the last two decades, particularly since 2020, probably influenced by the widespread antibiotic use during the COVID-19 pandemic. Recurrence and mortality rates remain significant challenges. These findings highlight the need for national surveillance programs, improved diagnostic protocols, and targeted interventions to mitigate the impact of CDI.

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