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Incidence of CDIs in Europe increased since 2008
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Thousands of Clostridium difficile infections are missed each year in Europe, according to data presented at the 2014 European Congress of Clinical Microbiology and Infectious Diseases.
Mark H. Wilcox, MD, FRCPath, professor of medical microbiology at Leeds Teaching Hospitals and University of Leeds, and colleagues presented their findings from the EUCLID trial that included 482 hospitals from 20 European countries.
Mark H. Wilcox
The data reveal that in a single day, an average of 109 cases of CDI are missed because of a lack of clinical suspicion or inadequate laboratory testing that could lead to more than 39,000 missed cases in Europe annually.
The incidence of CDI in Europe has increased (compared with previous studies) from 4.12 to 7.92 cases per 10,000 patient bed days between 2008 and 2013. In addition, the new data highlight that CDI PCR ribotype 027 is the most common type in Europe and one of the most virulent PCR ribotypes associated with CDI epidemics. Countries with the highest rates of CDI testing had the lowest rates of this epidemic C. difficile strain.
“Countries with increased awareness of CDI have probably been able to reduce outbreaks associated with the most virulent C. difficile strains by improving the early diagnosis of this usually health care-associated infection,” Wilcox said in a press release. “This study highlights that it is essential that we improve the implementation of CDI testing in hospitals in order to tackle the issue of the increasing incidence of CDI across Europe.”
The results compare data captured on two separate days, one in winter 2012-2013 and one in summer 2013. On each of the assigned days, participating hospitals submitted all received unformed fecal samples to the respective EUCLID national coordinating laboratories. In total, 7,181 fecal samples were submitted by participating hospitals.
These results highlight significant recent shifts in CDI testing policy and methodology across Europe, according to the researchers, which resulted in improved testing policies and selection of laboratory methods. The data also show that false-positive rates decreased between the two study days in those countries where testing procedures and methods had improved. Despite this, more than 50% of hospitals are still not using the most accurate testing procedure for CDI, and more than one in five (21.8%) samples found to be positive for CDI at the national coordinating laboratories had not been tested at the local hospital level. In addition, the findings reveal that 52.1% of hospitals in Europe only test for CDI at a physician’s request.
“Guidelines recommend that hospitals test for CDI on all unformed stools when the cause of diarrhea is not clear. However, we are still seeing an issue with both a lack of clinical suspicion and lack of testing for CDI,” Wilcox said. “CDI is a condition which causes considerable suffering for patients and a huge economic burden to hospitals across Europe. These results reveal that there is still more to be done in order to optimize CDI management and prevention.”
For more information:
Ashwin HM. Abstract #P0738. Presented at: ECCMID 2014; May 10-13, 2014; Barcelona, Spain.
Disclosure: The study was initiated and financially supported by Astellas Pharma Europe Ltd.