@article{3056676,
    title = "Point-prevalence survey of healthcare facilityonset healthcare-associated Clostridium difficile infection in Greek hospitals outside the intensive care unit: The C. DEFINE study",
    author = "Skoutelis, A. and Pefanis, A. and Tsiodras, S. and Sipsas, N.V. and Lelekis, M. and Lazanas, M.C. and Gargalianos, P. and Dalekos, G.N. and Roilides, E. and Samonis, G. and Maltezos, E. and Hatzigeorgiou, D. and Lada, M. and Metallidis, S. and Stoupis, A. and Chrysos, G. and Karnesis, L. and Symbardi, S. and Loupa, C.V. and Giamarellou, H. and Kioumis, I. and Sambatakou, H. and Tsianos, E. and Kotsopoulou, M. and Georgopali, A. and Liakou, K. and Perlorentzou, S. and Levidiotou, S. and Giotsa-Toutouza, M. and Tsorlini-Christoforidou, H. and Karaiskos, I. and Kouppari, G. and Trikka-Graphakos, E. and Ntrivala, M.-A. and Themeli-Digalaki, K. and Pangalis, A. and Kachrimanidou, M. and Martsoukou, M. and Karapsias, S. and Panopoulou, M. and Maraki, S. and Orfanou, A. and Petinaki, E. and Orfanidou, M. and Baka, V. and Stylianakis, A. and Spiliopoulou, I. and Smilakou, S. and Zerva, L. and Vogiatzakis, E. and Belesiotou, E. and Gogos, C.A.",
    journal = "PLOS ONE",
    year = "2017",
    volume = "12",
    number = "8",
    publisher = "Public Library of Science",
    doi = "10.1371/journal.pone.0182799",
    keywords = "antiinfective agent;  biological marker, aged;  clinical trial;  Clostridium Infections;  comorbidity;  cross infection;  diarrhea;  female;  Greece;  health care facility;  health survey;  hospital;  hospitalization;  human;  male;  microbiology;  middle aged;  multicenter study;  odds ratio;  Peptoclostridium difficile;  prevalence;  proportional hazards model;  risk factor;  sensitivity and specificity;  very elderly, Aged;  Aged, 80 and over;  Anti-Bacterial Agents;  Biomarkers;  Clostridium difficile;  Clostridium Infections;  Comorbidity;  Cross Infection;  Diarrhea;  Female;  Greece;  Health Facilities;  Hospitalization;  Hospitals;  Humans;  Male;  Middle Aged;  Odds Ratio;  Population Surveillance;  Prevalence;  Proportional Hazards Models;  Risk Factors;  Sensitivity and Specificity",
    abstract = "Background The correlation of Clostridium difficile infection (CDI) with in-hospital morbidity is important in hospital settings where broad-spectrum antimicrobial agents are routinely used, such as in Greece. The C. DEFINE study aimed to assess point-prevalence of CDI in Greece during two study periods in 2013. Methods There were two study periods consisting of a single day in March and another in October 2013. Stool samples from all patients hospitalized outside the ICU aged ≥18 years old with diarrhea on each day in 21 and 25 hospitals, respectively, were tested for CDI. Samples were tested for the presence of glutamate dehydrogenase antigen (GDH) and toxins A/B of C. difficile; samples positive for GDH and negative for toxins were further tested by culture and PCR for the presence of toxin genes. An analysis was performed to identify potential risk factors for CDI among patients with diarrhea. Results 5,536 and 6,523 patients were screened during the first and second study periods, respectively. The respective point-prevalence of CDI in all patients was 5.6 and 3.9 per 10,000 patient bed-days whereas the proportion of CDI among patients with diarrhea was 17% and 14.3%. Logistic regression analysis revealed that solid tumor malignancy [odds ratio (OR) 2.69, 95% confidence interval (CI): 1.18-6.15, p = 0.019] and antimicrobial administration (OR 3.61, 95% CI: 1.03-12.76, p = 0.045) were independent risk factors for CDI development. Charlson's Comorbidity Index (CCI) >6 was also found as a risk factor of marginal statistical significance (OR 2.24, 95% CI: 0.98-5.10). Median time to CDI from hospital admission was shorter with the presence of solid tumor malignancy (3 vs 5 days; p = 0.002) and of CCI >6 (4 vs 6 days, p = 0.009). Conclusions The point-prevalence of CDI in Greek hospitals was consistent among cases of diarrhea over a 6-month period. Major risk factors were antimicrobial use, solid tumor malignancy and a CCI score >6. © 2017 Skoutelis et al."
}