Sentinel surveillance and epidemiology of Clostridioides difficile in Denmark, 2016 to 2019 (original) (raw)
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Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2016
Suboptimal laboratory diagnostics for Clostridium difficile infection (CDI) impedes its surveillance and control across Europe. We evaluated changes in local laboratory CDI diagnostics and changes in national diagnostic and typing capacity for CDI during the European C. difficile Infection Surveillance Network (ECDIS-Net) project, through cross-sectional surveys in 33 European countries in 2011 and 2014. In 2011, 126 (61%) of a convenience sample of 206 laboratories in 31 countries completed a survey on local diagnostics. In 2014, 84 (67%) of these 126 laboratories in 26 countries completed a follow-up survey. Among laboratories that participated in both surveys, use of CDI diagnostics deemed 'optimal' or 'acceptable' increased from 19% to 46% and from 10% to 15%, respectively (p < 0.001). The survey of national capacity was completed by national coordinators of 31 and 32 countries in 2011 and 2014, respectively. Capacity for any C. difficile typing method increa...
Community- and Healthcare-Associated Clostridium difficile Infections, Finland, 2008−20131
Emerging Infectious Diseases, 2016
We evaluated incidence, case-fatality rate, and trends of community-associated (CA) and healthcare-associated (HA) Clostridium difficile infections (CDIs) in Finland during 2008-2013. CDIs were identified in the National Infectious Disease Register, deaths in the National Population Information System, hospitalizations to classify infections as CA or HA in the National Hospital Discharge Register, and genotypes in a reference laboratory. A total of 32,991 CDIs were identified: 10,643 (32.3%) were CA (32.9 cases/100,000 population) and 22,348 (67.7%) HA (69.1/100,000). Overall annual incidence decreased from 118.7/100,000 in 2008 to 92.1/100,000 in 2013, which was caused by reduction in HA-CDI rates (average annual decrease 8.1%; p<0.001). The 30-day case-fatality rate was lower for CA-CDIs than for HA-CDIs (3.2% vs. 13.3%; p<0.001). PCR ribotypes 027 and 001 were more common in HA-CDIs than in CA-CDIs. Although the HA-CDI incidence rate decreased, which was probably caused by increased awareness and improved infection control, the CA-CDI rate increased. C lostridium difficile is a common cause of antimicrobial-associated diarrhea in Finland (1) and elsewhere in Europe and Northern America (2,3). Dissemination of C. difficile genotypes with different virulence properties contributes to C. difficile infection (CDI) epidemiology (4-6). PCR ribotype 027 has been associated with more severe CDI outcomes (7-9), but not all studies have confirmed this finding (10). In Finland, hospitalizations associated with CDIs doubled during 1996-2004 (11). CDI laboratorybased surveillance was initiated in Finland in 2008, simultaneously with strengthening of infection control according to the European recommendations in several regions (8,12). During 2008-2010, a 24% reduction was observed in overall CDI incidence in Finland (13). CDI is typically a healthcare-associated (HA) disease, but there are indications that a notable proportion of cases are not associated with recent healthcare exposure (14-16). Some studies have shown that the incidence and severity of community-associated (CA) CDIs have been increasing (17). In Finland, the proportion of CA-CDIs among hospitalized patients in 16 acute-care hospitals was 16% during 2008-2010 (13). The purpose of this study was to compare CA-CDI with HA-CDI in terms of population-based incidence, case-fatality rates, and trends in Finland during 2008-2013. We obtained data from national registers and genotyping results from a reference laboratory. Methods In Finland (population 5.5 million), the national healthcare system is organized into 21 geographically and administratively defined healthcare districts, which have populations ranging from 28,700 to 1.6 million. Sixteen healthcare districts have primary-care and secondary-care hospitals, and 5 provide tertiary-care services. Since 2008, CDI reporting has been mandatory and all microbiology laboratories in Finland report C. difficile findings (positive cultures, toxin production, presence of toxin genes) for stool samples electronically to the National Infectious Disease Register (NIDR) (8). Each notification includes specimen date, each person's unique national identity code, date of birth, sex, and place of residence. In 2008, all laboratories used methods for detecting both TcdA and TcdB and 87% (20/23) used culture of C. difficile; 3 laboratories had started to use nucleic acid amplification tests (NAATs) for primary diagnostics (18). During 2011-2013, five laboratories were using NAATs as primary diagnostics tests. The National Hospital Discharge Register is a civil register comprising comprehensive healthcare records provided by all hospitals and primary-care wards in Finland, including outpatient surgery (i.e., day surgery). Each record includes the patient's national identity code, admission and discharge dates, healthcare provider code, type of service, specialty, and place (home or institution) from which the patient came to the hospital. Since 2008, clinical microbiology laboratories have been requested to send C. difficile isolates from severe cases (CDI-related intensive care, colectomy, or death)
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2016
Clostridium difficile infection (CDI) represents a great healthcare burden in developed countries. The emergence of the epidemic PCR ribotype (RT) 027 and its acquired fluoroquinolones resistance have accentuated the need for an active surveillance of CDI. Here we report the first countrywide study of CDI in Portugal with the characterization of 498 C. difficile clinical isolates, from 20 hospitals, comprising four regions in Portugal, regarding RT, virulence factors and antimicrobial susceptibility. We identified 96 RTs with marked variations between and within regions, as only six RTs appeared in all four regions. RT027 was the most frequent RT overall (18.5%) and among healthcare facility-associated isolates (19.6%), while RT014 was the most common among community-associated isolates (12%). The North showed a high RT diversity among isolates and a low moxifloxacin (MXF) resistance rate (11.9%), being the only region in which RT027 was not predominant. In contrast, the isolates fr...
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy, 2018
Clostridium difficile, recently reclassified as Clostridioides difficile is responsible for a significant part of diarrheal diseases in the hospitals and in the community. Besides the main pathogenic factors, toxin A, toxin B and the binary toxin, several other putative virulence factors have been investigated. This manuscript summarize recent findings in Europe concerning source of infection, epidemiology of CDI, the changing pattern of PCR ribotypes of C. difficile strains in different European countries, recommendations for diagnosis and treatment of CDI.
Community- and Healthcare- Associated Clostridium difficile Infections, Finland, 2008-2013
WOS, 2016
We evaluated incidence, case-fatality rate, and trends of community-associated (CA) and healthcare-associated (HA) Clostridium difficile infections (CDIs) in Finland during 2008-2013. CDIs were identified in the National Infectious Disease Register, deaths in the National Population Information System, hospitalizations to classify infections as CA or HA in the National Hospital Discharge Register, and genotypes in a reference laboratory. A total of 32,991 CDIs were identified: 10,643 (32.3%) were CA (32.9 cases/100,000 population) and 22,348 (67.7%) HA (69.1/100,000). Overall annual incidence decreased from 118.7/100,000 in 2008 to 92.1/100,000 in 2013, which was caused by reduction in HA-CDI rates (average annual decrease 8.1%; p<0.001). The 30-day case-fatality rate was lower for CA-CDIs than for HA-CDIs (3.2% vs. 13.3%; p<0.001). PCR ribotypes 027 and 001 were more common in HA-CDIs than in CA-CDIs. Although the HA-CDI incidence rate decreased, which was probably caused by increased awareness and improved infection control, the CA-CDI rate increased. C lostridium difficile is a common cause of antimicrobial-associated diarrhea in Finland (1) and elsewhere in Europe and Northern America (2,3). Dissemination of C. difficile genotypes with different virulence properties contributes to C. difficile infection (CDI) epidemiology (4-6). PCR ribotype 027 has been associated with more severe CDI outcomes (7-9), but not all studies have confirmed this finding (10). In Finland, hospitalizations associated with CDIs doubled during 1996-2004 (11). CDI laboratorybased surveillance was initiated in Finland in 2008, simultaneously with strengthening of infection control according to the European recommendations in several regions (8,12). During 2008-2010, a 24% reduction was observed in overall CDI incidence in Finland (13). CDI is typically a healthcare-associated (HA) disease, but there are indications that a notable proportion of cases are not associated with recent healthcare exposure (14-16). Some studies have shown that the incidence and severity of community-associated (CA) CDIs have been increasing (17). In Finland, the proportion of CA-CDIs among hospitalized patients in 16 acute-care hospitals was 16% during 2008-2010 (13). The purpose of this study was to compare CA-CDI with HA-CDI in terms of population-based incidence, case-fatality rates, and trends in Finland during 2008-2013. We obtained data from national registers and genotyping results from a reference laboratory. Methods In Finland (population 5.5 million), the national healthcare system is organized into 21 geographically and administratively defined healthcare districts, which have populations ranging from 28,700 to 1.6 million. Sixteen healthcare districts have primary-care and secondary-care hospitals, and 5 provide tertiary-care services. Since 2008, CDI reporting has been mandatory and all microbiology laboratories in Finland report C. difficile findings (positive cultures, toxin production, presence of toxin genes) for stool samples electronically to the National Infectious Disease Register (NIDR) (8). Each notification includes specimen date, each person's unique national identity code, date of birth, sex, and place of residence. In 2008, all laboratories used methods for detecting both TcdA and TcdB and 87% (20/23) used culture of C. difficile; 3 laboratories had started to use nucleic acid amplification tests (NAATs) for primary diagnostics (18). During 2011-2013, five laboratories were using NAATs as primary diagnostics tests. The National Hospital Discharge Register is a civil register comprising comprehensive healthcare records provided by all hospitals and primary-care wards in Finland, including outpatient surgery (i.e., day surgery). Each record includes the patient's national identity code, admission and discharge dates, healthcare provider code, type of service, specialty, and place (home or institution) from which the patient came to the hospital. Since 2008, clinical microbiology laboratories have been requested to send C. difficile isolates from severe cases (CDI-related intensive care, colectomy, or death)
Antibiotics
Clostridioides difficile remains an important public health threat, globally. Since the emergence of the hypervirulent strain, ribotype 027, new strains have been reported to cause C. difficile infection (CDI) with poor health outcomes, including ribotypes 014/020, 017, 056, 106, and 078/126. These strains differ in their geographic distribution, genetic makeup, virulence factors, and antimicrobial susceptibility profiles, which can affect their ability to cause disease and respond to treatment. As such, understanding C. difficile epidemiology is increasingly important to allow for effective prevention measures. Despite the heightened epidemiological surveillance of C. difficile over the past two decades, it remains challenging to accurately estimate the burden and international epidemiological trends given the lack of concerted global effort for surveillance, especially in low- and middle-income countries. This review summarizes the changing epidemiology of C. difficile based on av...
Clostridium difficile Infection Epidemiology over a Period of 8 Years—A Single Centre Study
Sustainability
Clostridium difficile infection (CDI) is the most common infectious disease related to antibiotic-associated diarrhoea and is a current leading cause of morbidity/mortality, with substantial consequences for healthcare services and overall public health. Thus, we performed a retrospective epidemiological study of CDI for a long period (8 years), in an infectious hospital located in north-western Romania, which serves an entire county of the country (617,827 inhabitants). From 2011 to 2018, 877 patients were diagnosed with CDI; the mean incidence of this disease was 2.76 cases/10,000 patient-days, with an increasing trend in the annual incidence until 2016, at which point there was a decrease. The most commonly afflicted were patients in the 75–84 age group, observed in winter and spring. The results show that the antibiotics were administered in 679 (77.42%) subjects, within the last 3 months before CDI, statistically significant more than proton-pump inhibitors (PPIs)—128 (14.60%) ...