Clostridium difficile, are all our patients diagnosed?]

Background: A close correlation between clinical and microbiological diagnosis in Clostridium difficile infection (CDI) is very important to identify how severe is this health problem, and to approach its correct management of it, individually and as a population problem. Objetives: a) To evaluate if there is an adequate correlation between the microbiological and clinical diagnosis in CDI patients; b) to determine if the discordance between the microbiological and clinical diagnosis could be associated with different clinical patient characteristics, therapeutic attitudes, and outcomes. Patients and methods: A retrospective study was conducted, using clinical and epidemiologic data, on inpatients with a microbiological diagnosis of CDI in 2013 in the Hospital Clinico San Carlos in Madrid (Spain), depending on whether their clinical ICD diagnosis was included. Results: From a total of 33,317 discharged patients, 204 patients had a CDI diagnosis. Only 51.5% patients had this diagnosis stated in their discharge report. Patients on whom the clinical diagnosis was included, were older, had higher level of dependence (P<.05), and received treatment for CDI more frequently (P <.001) than patients who did not have the clinical diagnosis included. A lower treatment rate was associated with a higher mortality (P=.032) Conclusions: Nearly half of patients with a microbiological diagnosis of CDI did not have the clinical diagnosis included in their clinical report. Patients without the clinical diagnosis were younger, had less disability, and received specific antibiotics for CDI less frequently. Not receiving specific antibiotics for CDI was associated with higher mortality. (C) 2014 SECA. Published by Elsevier Espana, S.L.U. All rights reserved.