Clostridium difficile infection in Europe: a hospital-based surveyArchived

Clostridium difficile infection in Europe: a hospital-based survey

Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, Monnet DL, van Dissel JT, Kuijper EJ; ECDIS Study Group.

Lancet. 2011 Jan 1;377(9759):63-73.

Clostridium difficile infection is the leading cause of healthcare-associated diarrhoea in the developed world and represents a major financial burden for European healthcare systems. However, little is known about the extent of this type of infection in Europe.

To obtain a more complete overview of C. difficile infections in Europe, the authors set up a hospital-based survey including 106 hospitals in 34 European countries, including all 27 EU Member States, 3 candidate countries and 1 EFTA country. The purpose of this study was to better understand the epidemiology of C. difficile infection in Europe, as well as to build capacity for diagnosis and surveillance at the national and European level.

The major finding was that the incidence of C. difficile infection differed greatly between participating hospitals with a striking high overall and associated mortality. The risk factors for C. difficile infection were old age, various comorbidities and recent antibiotic use, as previously described, whereas the risk factors for complicated disease outcome were age of 65 or older and infection with PCR-ribotypes 018 and 056. Interestingly, the study showed that many PCR-ribotypes other than 027 were also prevalent in Europe.

ECDC comment: This study, funded by ECDC, was the first pan-European study on C. difficile infection. The study contributed to building capacity for the diagnosis of C. difficile infections in European countries and underscores the importance of both multi-country and local surveillance to detect and control endemic and epidemic C. difficile infections in Europe.