Features of Clostridioides difficile healthcare‑associated infection in a multidisciplinary hospital

   Clostridioides difficile is a leading causative agent of nosocomial antibiotic-associated diarrhea. Spore formation, resistance to alcohol-based antiseptics, and the fecal-oral transmission route complicate infection control in high-risk departments.

   Objective. To study the prevalence, structure, and risk factors of C. difficile infection in a multidisciplinary hospital to optimize epidemiological monitoring and preventive measures.

   Materials and methods. The analysis includes the results of stool samples from 5,209 patients tested for C. difficile toxins; C. difficile infection (CDI) was confirmed in 860 cases. Epidemiological, enzyme immunoassay (EIA), and statistical methods of investigation were applied.

   Results. Clostridioides difficile- infection prevails in intensive care, oncology, transplantation, nephrology, and gastroenterology departments. Antibiotic therapy remains the primary trigger of the disease. The COVID-19 epidemic led to an increase in nosocomial incidence, while an influx of patients admitted to the hospital with pre-existing CDI symptoms has been observed since 2021. Bone marrow transplant recipients are the most vulnerable cohort to recurrent infection. In gastroenterological patients, CDI manifests within the first 48 hours, requiring differential diagnosis with exacerbation of inflammatory bowel diseases. The frequency of CDI in nephrology, cardiology, and oncology patients exceeds that in surgical departments. The mortality rate among patients tested for C. difficile toxins was 15.3 %, and the share of CDI in the structure of hospital mortality reached 31.5 %.

   Conclusion. The biological properties of C. difficile significantly complicate the localization of outbreaks and containment of infection spread in high-risk departments. Along with antibiotic therapy, patient age, comorbidity, and invasive interventions shape a specific epidemic process in each department. During the COVID-19 epidemic, an activation of the CDI epidemic process was noted, particularly among bone marrow recipients. A comprehensive set of measures is required to reduce morbidity, including hand hygiene with soap, strict patient isolation, the use of sporicedal chlorine-containing disinfectants, and continuous training of medical personnel.

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