Background: Clostridium difficile infection is the leading cause of gastroenteritis-associated deaths in the industrialized world, followed by infection with norovirus.Methods: Using a cohort study design, we compared 90 inpatients with diarrhea due to C. difficile infection (CDI) with 180 inpatients with diarrhea due to other infectious agents (including 55% with norovirus infection) with respect to complications and all-cause mortality. The effects of age, severity of underlying diseases and additional infections were assessed by stratified analyses.Results: Diarrhea recurrence occurred 8.9 (95%Cl: 2.9-27.3) times more often in CDI independent of age and severity of comorbidities. The all-cause mortality in CDI patients pre-discharge and at 30 and 180 days, respectively, was 20.0%, 17.0% and 42.3% versus 7.2%, 6.7% and 22.5% in non -CDI diarrhea patients. Among those patients with low comorbidities, who were younger than 65 years and without additional infections, the all-cause pre-discharge, 30-day and 180-day mortality risks were significantly higher for the CDI diarrhea patients than the non-CDI diarrhea patients. This association was not observed among patients with an older age, more severe comorbidities or additional infections.Conclusion: CDI results in higher all-cause mortality than diarrhea due to other infectious agents in younger patients with low comorbidities. (C) 2013 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

On 28th November 2011, a school physician informed the Austrian Agency for Health and Food Safety (AGES) of 40 cases of gastroenteritis that occurred on 24th and 25th November in a vocational school in the city of Salzburg, Austria. Two out of five students with gastroenteritis tested positive for norovirus (NV). A probable case involved diarrhoea or vomiting in a student, which occurred between 21st November and 5th December 2011. A confirmed case was a probable case with an NV-positive stool sample. Epidemiological findings led to suspect food items prepared by the school kitchen and consumed between 21st and 25th November as outbreak sources. All students at the school were eligible to be included in a retrospective cohort study. Forty-eight cases fulfilled the outbreak case definitions including three (6%) confirmed cases among a total of 351 responding students. The outbreak started on 23th November, peaked on 24th and ended on 5th December. The cohort study indicated a sour cream sauce (food-specific relative risk (RR): 16.1; 95% CI: 3.9-67.5) and a turkey-strip salad (RR: 5.2; 95% CI: 2.3-11.8) as the most likely sources, accounting for 85% of the 39 suspected foodborne cases.

A cluster of gastroenteritis due to infection with Salmonella Typhimurium DT3 affected attendees of a party in Vienna, July 13th 2011. We defined a probable outbreak case as gastroenteritis (at least three loose stools per day) in a party attendee with disease onset between July 14th and 21st. A confirmed case had in addition a stool sample positive for S. Typhimurium DT3. The descriptive epidemiology suggested party dishes as the most likely outbreak source(s). All 39 party guests were included in a cohort study to test this hypothesis. Food samples (including left-over samples) and samples from traced livestock were tested for Salmonella and recovered isolates genotyped. Twenty five guests fulfilled the outbreak case definition (including twelve confirmed cases). According to disease onset, the outbreak lasted from July 14th-17th, indicating a point source. Dishes at the party included cakes and a ready-to-eat pickled cabbage salad purchased by the host and a roast suckling pig with egg-containing dumpling filling and potato salad produced by the caterer, who operated the pig farm involved. Faeces and dust samples from the pig farm and dust and egg samples from the traced laying hen holding tested positive for S. Typhimurium DT3. The isolates from the human cases and the two outbreak-related livestock shared indistinguishable PFGE and VNTR patterns. The cohort study indicated the potato salad prepared in parallel to the suckling pig and the egg-containing filling as the possible outbreak source. Another S. Typhimurium DT3 outbreak in August 2011 was traced to the same laying hen holding. After culling of the S. Typhimurium DT3 positive flocks on August 31st 2011, no more S. Typhimurium DT3 cases were notified as of May 2012.

Risk factors of severity (need for surgical intervention, intensive care or fatal outcome) were analysed in hospital-acquired Clostridium difficile infection (CDI) in a 777-bed community hospital. In a prospective analytical cross-sectional study, age (≥65 years), sex, CDI characteristics, underlying diseases, severity of comorbidity and PCR ribotypes were tested for associations with severe CDI. In total, 133 cases of hospital-acquired CDI (mean age 74.4 years) were identified, resulting in an incidence rate of 5.7/10,000 hospital-days. A recurrent episode of diarrhoea occurred in 25 cases (18.8%) and complications including toxic megacolon, dehydration and septicaemia in 69 cases (51.9%). Four cases (3.0%) required ICU admission, one case (0.8%) surgical intervention and 22 cases (16.5%) died within the 30-day follow-up period. Variables identified to be independently associated with severe CDI were severe diarrhoea (odds ratio [OR] 3.64, 95% confidence interval [CI] 1.19–11.11, p = 0.02), chronic pulmonary disease (OR 3.0, 95% CI 1.08–8.40, p = 0.04), chronic renal disease (OR 2.9, 95% CI 1.07–7.81, p = 0.04) and diabetes mellitus (OR 4.30, 95% CI 1.57–11.76, p = 0.004). The case fatality of 16.5% underlines the importance of increased efforts in CDI prevention, in particular for patients with underlying diseases.