# The Incidence of Clostridioides difficile Infection in the Post-COVID-19 Era in a Hospital in Northern Greece

## TL;DR

This study examines the rising incidence and high mortality of Clostridioides difficile infection in a Greek hospital during 2022-2023, highlighting the need for better infection control.

## Contribution

The study reports a high CDI incidence and mortality in northern Greece, suggesting the emergence of hypervirulent strains.

## Key findings

- CDI incidence reached 54.6/10,000 patient days, higher than previous regional reports.
- Thirty-day mortality was 39.4%, potentially linked to hypervirulent C. difficile strains.
- The study emphasizes the need for surveillance and infection prevention protocols in the region.

## Abstract

Clostridioides difficile infection (CDI) has evolved to be the most significant cause of healthcare-associated diarrhoea and one of the leading representatives of healthcare-associated infections, with a high associated mortality. The aim of this retrospective study was to record the incidence rates and the epidemiological and clinical features of CDI in a large tertiary hospital of northern Greece in the years 2022-2023. All patients with CDI-compatible symptomatology and a positive CDI diagnostic test (GDH—glutamate dehydrogenase and toxin-positive FIA—Fluorescent Immuno-chromatography—SD Biosensor, and/or film array) were included (104 from a total of 4560 admitted patients). Their demographic, laboratory, and clinical data were recorded and analysed. The incidence of CDI in admitted patients was found to be higher than previous reports in the geographical area, reaching 54.6/10,000 patient days and following a rising trend over the course of the study. Thirty-day mortality was high (39.4%), potentially related to new emerging hypervirulent C. difficile strains. In view of the high prevalence of multidrug-resistant organisms in the region, and the significant mortality associated with this infection, these findings particularly point to the need for the implementation of organized surveillance and infection prevention protocols.