Objective: To study the epidemiology and severity of C. difficile infections (CDI) at Landspítali over 11 year period, 1998-2008.

Material and methods: CDI were identified by a positive toxin assay in stools from the database of the Department of Microbiology. Chart review was conducted on patients diagnosed in January and June each year during the study period, a total of 237 infections.

Results:Overall, 1,861 of 11,968 submitted stool samples were positive for C. difficile toxin, representing 1,492 infections. The population-based incidence was 29% higher in the end than in the beginning of the period and was highest in the age group >80 years where it was 387 cases per 100,000 person-years. The incidence per 1,000 admissions and 10,000 hospital days increased by 71% and 102%, respectively. 47% of the infections were nosocomial. Most patients had history of antibiotic exposure prior to the infection and the most common symptom was diarrhea. Response to a single antibiotics course was good (93%). No patient required surgery due to colitis.

Conclusion: The incidence of CDI was higher in 2008 than 11 years before. Most patients had well characterized risk factors for CDI. For most patients a single course of metronidazole treatment resolved the infection. Based on these data, the severity of CDI does not seem to be increasing in Iceland.

Figure 1. Rate, gender division and incidence of CDI at Landspítali University Hospital per 100,000 inhabitants of Iceland the years 1998-2008. Information about  population is from Statistics Iceland.15

Figure 2. CDI incidence by age at Landspítali University Hospital per 100,000 men, women and inhabitants of Iceland the years 1998-2008. Information about population is from Statistics Iceland.15

Figure 3. CDI rate at Landspítali University Hospital by month and per 10,000 admissions each month the years 1998-2008.

Table I. CDI at Landspítali University Hospital compared to admissions and patient days. Information about admissions and patient days was gathered from the operation information of Landspítali University Hospital and annual reports of Hospital of Reykjavík and State Hospital.16-19