Clostridioides difficile infections caused by hypervirulent strains: a single-centre real-life study

Area of Science:

• Infectious Diseases
• Epidemiology
• Microbiology

Background:

• Clostridioides difficile infection (CDI) is a significant global healthcare-associated infection.
• Hypervirulent strains of C. difficile are associated with increased disease severity and mortality.
• Understanding the epidemiology of CDI, particularly hypervirulent strains, is critical for effective management.

Purpose of the Study:

• To analyze the epidemiological trends of CDI at a tertiary-care hospital in Italy.
• To compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent C. difficile strains.
• To identify risk factors associated with hypervirulent CDI.

Main Methods:

• Retrospective comparative study of CDI patients from January 2015 to June 2023.
• Identification of hypervirulent strains using GeneXpert assay (tcdB, tcdA, tcdB, tcdC deletion).
• Multivariate logistic regression analysis to determine risk factors and mortality predictors.

Main Results:

• A statistically significant increasing trend in CDI incidence was observed.
• A notable increase in hypervirulent strains was recorded in 2021-2022.
• Hypervirulent CDI was associated with significantly higher 30-day mortality (18% vs. 5.8%) and prior antibiotic therapy was a risk factor.

Conclusions:

• Epidemiological data suggest a potential resurgence of CDI, possibly linked to the COVID-19 pandemic.
• The findings underscore the need for enhanced antimicrobial stewardship programs.
• Strengthened national surveillance systems are essential for monitoring and managing hypervirulent C. difficile strains.