Clostridium difficile infection in Europe: a hospital-based survey - PubMed (original) (raw)
Multicenter Study
. 2011 Jan 1;377(9759):63-73.
doi: 10.1016/S0140-6736(10)61266-4.
Collaborators, Affiliations
- PMID: 21084111
- DOI: 10.1016/S0140-6736(10)61266-4
Multicenter Study
Clostridium difficile infection in Europe: a hospital-based survey
Martijn P Bauer et al. Lancet. 2011.
Abstract
Background: Little is known about the extent of Clostridium difficile infection in Europe. Our aim was to obtain a more complete overview of C difficile infection in Europe and build capacity for diagnosis and surveillance.
Methods: We set up a network of 106 laboratories in 34 European countries. In November, 2008, one to six hospitals per country, relative to population size, tested stool samples of patients with suspected C difficile infection or diarrhoea that developed 3 or more days after hospital admission. A case was defined when, subsequently, toxins were identified in stool samples. Detailed clinical data and stool isolates were collected for the first ten cases per hospital. After 3 months, clinical data were followed up.
Findings: The incidence of C difficile infection varied across hospitals (weighted mean 4·1 per 10,000 patient-days per hospital, range 0·0-36·3). Detailed information was obtained for 509 patients. For 389 of these patients, isolates were available for characterisation. 65 different PCR ribotypes were identified, of which 014/020 (61 patients [16%]), 001 (37 [9%]), and 078 (31 [8%]) were the most prevalent. The prevalence of PCR-ribotype 027 was 5%. Most patients had a previously identified risk profile of old age, comorbidity, and recent antibiotic use. At follow up, 101 (22%) of 455 patients had died, and C difficile infection played a part in 40 (40%) of deaths. After adjustment for potential confounders, an age of 65 years or older (adjusted odds ratio 3·26, 95% CI 1·08-9·78; p=0·026), and infection by PCR-ribotypes 018 (6·19, 1·28-29·81; p=0·023) and 056 (13·01; 1·14-148·26; p=0·039) were significantly associated with complicated disease outcome.
Interpretation: PCR ribotypes other than 027 are prevalent in European hospitals. The data emphasise the importance of multicountry surveillance to detect and control C difficile infection in Europe.
Funding: European Centre for Disease Prevention and Control.
Copyright © 2011 Elsevier Ltd. All rights reserved.
Comment in
- Pathogenic C difficile is here (and everywhere) to stay.
Warren CA, Guerrant RL. Warren CA, et al. Lancet. 2011 Jan 1;377(9759):8-9. doi: 10.1016/S0140-6736(10)61885-5. Lancet. 2011. PMID: 21084110 No abstract available. - Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland.
Nyč O, Pituch H, Matějková J, Obuch-Woszczatynski P, Kuijper EJ. Nyč O, et al. Lancet. 2011 Apr 23;377(9775):1407. doi: 10.1016/S0140-6736(11)60575-8. Lancet. 2011. PMID: 21515161 No abstract available. - C. difficile infection - Can we do better?
Coia J. Coia J. Clin Microbiol Infect. 2018 May;24(5):450-451. doi: 10.1016/j.cmi.2017.12.009. Epub 2017 Dec 20. Clin Microbiol Infect. 2018. PMID: 29274464 No abstract available.
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