Resistance to MLS(B) and fluoroquinolone antimicrobial compounds is common among prevalent ribotypes of C. difficile. The genetic basis for antimicrobial resistance appears to be ribotype specific and conserved in the absence of recent antimicrobial selection pressure.
In the Republic of Ireland, new cases of Clostridium difficile infection (CDI) have been notifiable since May 2008, with the use of interim European case definitions. 1 These case definitions are comparable to definitions that have been proposed in the United States. 2 During the period from May 2008 through December 2009, 3,538 new cases of CDI were notified in the Republic of Ireland. 3 This reflects an underestimation of the true burden of CDI, because recurrent cases are not captured. Because there is no C. difficile reference laboratory in the Republic of Ireland, no national collation of ribotypes exists. Irish healthcare facilities (HCFs) were invited to participate in a 1-month national C. difficile typing and enhanced surveillance project. Participants were requested to forward fecal specimens and clinical details on all CDI cases diagnosed during the period from March 1 through March 31, 2009. Standardized definitions of CDI case type, origin, and onset of infection and case severity were used. 1 Isolates were characterized by polymerase chain reaction (PCR) ribotyping, as described elsewhere. 4
Background
In 2020, due to the COVID-19 pandemic, the European Centre for Disease Prevention and Control (ECDC) accelerated development of European-level severe acute respiratory infection (SARI) surveillance.
Aim
We aimed to establish SARI surveillance in one Irish hospital as part of a European network E-SARI-NET.
Methods
We used routine emergency department records to identify cases in one adult acute hospital. The SARI case definition was adapted from the ECDC clinical criteria for a possible COVID-19 case. Clinical data were collected using an online questionnaire. Cases were tested for SARS-CoV-2, influenza and respiratory syncytial virus (RSV), including whole genome sequencing (WGS) on SARS-CoV-2 RNA-positive samples and viral characterisation/sequencing on influenza RNA-positive samples. Descriptive analysis was conducted for SARI cases hospitalised between July 2021 and April 2022.
Results
Overall, we identified 437 SARI cases, the incidence ranged from two to 28 cases per week (0.7–9.2/100,000 hospital catchment population). Of 431 cases tested for SARS-CoV-2 RNA, 226 (52%) were positive. Of 349 (80%) cases tested for influenza and RSV RNA, 15 (4.3%) were positive for influenza and eight (2.3%) for RSV. Using WGS, we identified Delta- and Omicron-dominant periods. The resource-intensive nature of manual clinical data collection, specimen management and laboratory supply shortages for influenza and RSV testing were challenging.
Conclusion
We successfully established SARI surveillance as part of E-SARI-NET. Expansion to additional sentinel sites is planned following formal evaluation of the existing system. SARI surveillance requires multidisciplinary collaboration, automated data collection where possible, and dedicated personnel resources, including for specimen management.
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