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Journal of Environmental Protection and Ecology 16, No 1, 352355 (2015)

Public health environmental medicine

Clostridium difficile ENTEROCOLITIS: CURRENT PUBLIC


HEALTH PROBLEM
S. HALICHIDISa, R. M. STOICESCUb*, D. S. CARPa, C. S. CAMBREAa
Clinical Infectious Diseases Hospital of Constanta, Constanta, Romania
Faculty of Pharmacy, Ovidius University Constanta, Al. Universitatii
Campus, Corp B, 900470 Constanta, Romania
E-mail: stoicescu.ramona@gmail.com

Abstract. The purpose of this study is to draw attention about the risk of increasing incidence of
Clostridium difficile infections, in order to improve the diagnosis, the treatment and to prevent the
spreading of this disease. We studied all the patients with C. difficile enterocolitis hospitalised in
Clinical Infectious Diseases Hospital of Constanta and the patients with the same condition hospitalised in Clinical Emergency County Hospital of Constanta, who were examined by infectious
diseases specialists. The study was conducted between January 2013June 2014 period during
which we registered 123 patients. The most frequent symptoms were: watery diarrhea, fever, loss of
appetite, nausea, abdominal pain or tenderness. Under the treatment that consisted of Vancomycin
or Metronidazole or Tigecycline, the evolution was prolonged but good in majority of the cases,
only 2 patients died because of other associated diseases. The increasing incidence is caused by the
misuse of antibiotics.
Keywords: Clostridium difficile enterocolitis, antibiotherapy, public health.

AIMS AND BACKGROUND


Clostridium difficile (C. difficile) infection is caused by a Gram-positive, rodshaped, anaerobic bacteria which can disrupt normal bowel function, under certain
circumstances, such as immunosuppressed patients or after antibiotherapy, causing pseudomembranous colitis and watery diarrhea. This infection is common
especially in people in healthcare facilities who have received antimicrobials1. A
high risk category is represented by the extreme ages of life: old patients, with
associated diseases and decreased immunity2, but also children with undeveloped
immune system. After respiratory infections, diarrhea is the most common disease
in children3. The bacterium can be transmitted through either personal contact or
the environment4. C. difficileis transmitted by thefecal-oral route. C. difficilecan
form heat-resistant spores that are not killed by alcohol-based hand cleansers or
routine surface cleaning. The spores are able to survive in clinical environments
for extended periods. Once spores are ingested, their acid-resistance allows them
*

For correspondence.

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to pass through the stomach unscathed and exposed tobile acids, they germinate
into vegetative cells and multiply in the colon.
Antibiotic treatment of C. difficile may be difficult, due to both antibiotic
resistanceand physiological factors of the bacteria such as spore formation and
the protective effects of the pseudomembrane.
The purpose of this study is to draw attention about the risk of increasing incidence of Clostridium difficile infections in Romania in general, and in Constanta,
particularly, in order to diagnose, treat and prevent the spreading of this disease.
The prior administration of some drugs may promote illness5, antibiotics being
possible risk factors for the occurrence of this disease. We also noticed Clostridium
difficile infections in children without a previous exposure on antibiotherapy and,
maybe, the explanation can be the consumption of the food already wearing traces
of antibiotics. The use of small doses of antibiotics in food products has a negative
impact for the human health because of the possible transmission of the resistance
on antibiotics6 or promoting some diseases, like those caused by Clostridium difficile infections.
EXPERIMENTAL
We studied all the patients with C. difficile enterocolitis who were hospitalised
in Clinical Infectious Diseases Hospital of Constanta and the patients with the
same condition that were hospitalised in Clinical Emergency County Hospital of
Constanta, who were examined by infectious diseases specialists, between January 2013June 2014.
The diagnosis was based on microbiological investigations of the stools and
the determination of the C. difficile toxin.
In Clinical Infectious Diseases Hospital of Constanta, Romania, the management of Clostridium difficile infections are following the guidelines in the field
and are closely monitored by the Nosocomial Infections Department7.
RESULTS AND DISCUSSION
During the studied period, we registered 56 patients in 2013 and 67 in 2014 (Fig. 1).

Fig. 1. Distribution of the patients by year

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Out of the 123 studied patients, 78 were hospitalised in Infectious Diseases


Hospital and 45 were hospitalised in other medical wards and were examined by
our infectious diseases specialists (Fig. 2).

Fig. 2. Distribution of the patients by hospitalisation place

Of the studied patients, 64.1% lived in urban area (Fig. 3) and 58.97% were
women (Fig. 4).

Fig. 3. Distribution of the patients by area

Fig. 4. Distribution of the patients by gender

The most frequent symptoms of the patients were: watery diarrhea, fever, loss
of appetite, nausea, abdominal pain or tenderness.
Under the treatment that consisted of Vancomycin or Metronidazole or Tigecycline, the evolution was prolonged but favourable in majority of the cases, only
2 patients died because of other associated diseases8.

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CONCLUSIONS
C. difficile infection is a frequent disease registered in the recent years in Romania,
causing serious problems in assisting, treating and isolation of the affected patients.
The increasing incidence and the severity of the disease must fire a warning related
with the abuse of antibiotics using in our country, requiring the improvement of
the present health policy related to antibiotherapy.
The dramatic changes in the epidemiology of Clostridium difficile infection
have made a global public health challenge9.
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Received 6 October 2014
Revised 22 November 2014

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