Clostridium difficile is an anaerobic bacterium, widely distributed in soil and intestinal tracts of animals. The clinical spectrum of C. difficile infection (CDI) ranges from mild diarrhoea to severe life threatening pseudomembranous colitis. The disease is generally, but not always associated with previous use of antibiotics. There is an increase of reports of community-acquired CDI in individuals previously not recognized as predisposed. CDI is also recognised increasingly in a variety of animal species. The transmission of C. difficile can be patient-to-patient, via contaminated hands of healthcare workers or by environmental contamination.
The impact of CDI on modern healthcare is significant. In terms of costs, this translates into €5 000 – 15 000 per case in England and $1.1 billion per year in the USA. Assuming the population of European Union to be 500 million, CDI can be estimated to potentially cost the Union €3 000 million per annum. It is expected to almost double over the next four decades.
Since March 2003, increasing rates of CDI have been reported in Canada and USA with a more severe course, higher mortality, and more complications. This increased virulence was partly associated with the spread of fluoroquinolone-resistant strains belonging to PCR ribotype 027. This new, highly virulent strain of C. difficile PCR ribotype 027 was first reported in Europe in 2005. Although cases of CDI due to C. difficile PCR ribotype 027 were reported in hospitals in many European countries, the European study on C. difficile infection (ECDIS, Bauer MP et al.,2011.) – showed that the most common PCR ribotypes in Europe were 014 and 020 (found in 19 countries), 001 (in 13 countries) and 078 (in 18 countries); PCR-ribotype 027 ranked sixth and was reported in 6 countries.
Clostridium difficile outbreaks are very difficult, although not impossible to control. Vonberg R-P et al., 2008 on behalf of the European C. difficile Infection Control Group and the European Centre for Disease Prevention and Control (ECDC) produced evidence-based guidance for the prevention and control of CDI and C. difficile outbreaks. They proposed the following recommendations to limit the spread of C. difficile in healthcare settings:
- early diagnosis of CDI
- surveillance of CDI cases
- education of the hospital and cleaning personnel as well as patients and visitors
- appropriate use of isolation precautions
- hand hygiene
- protective clothing
- environmental cleaning and cleaning of the medical equipment
- responsible antibiotic therapy, and
- specific measures during outbreaks.