Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013

Abstract

Clostridium difficile infection (CDI) remains poorly controlled in many European countries, of which several have not yet implemented national CDI surveillance. In 2013, experts from the European CDI Surveillance Network project and from the European Centre for Disease Prevention and Control developed a protocol with three options of CDI surveillance for acute care hospitals: a 'minimal' option (aggregated hospital data), a 'light' option (including patient data for CDI cases) and an 'enhanced' option (including microbiological data on the first 10 CDI episodes per hospital). A total of 37 hospitals in 14 European countries tested these options for a three-month period (between 13 May and 1 November 2013). All 37 hospitals successfully completed the minimal surveillance option (for 1,152 patients). Clinical data were submitted for 94% (1,078/1,152) of the patients in the light option; information on CDI origin and outcome was complete for 94% (1,016/1,078) and 98% (294/300) of the patients in the light and enhanced options, respectively. The workload of the options was 1.1, 2.0 and 3.0 person-days per 10,000 hospital discharges, respectively. Enhanced surveillance was tested and was successful in 32 of the hospitals, showing that C. difficile PCR ribotype 027 was predominant (30% (79/267)). This study showed that standardised multicountry surveillance, with the option of integrating clinical and molecular data, is a feasible strategy for monitoring CDI in Europe.

Risk factors for Clostridium difficile infections – an overview of the evidence base and challenges in data synthesis

“…The paucity of evidence on CDI incidence and strength of association of different risk factors is worrisome in view of the potential wide–spread of hyper–virulent strains of C. difficile as seen for BI/NAP1/027 [16]. Additional, well–designed studies and standardised surveillance methods [64] that integrate clinical and epidemiological data are required in these settings to assess the role of multiple in–hospital and community factors –which may differ from high–resource settings − that can have an impact on CDI or rCDI.…”

How to: Surveillance of Clostridium difficile infections

“…They reported that data collection was 'not difficult' for both the light option (88% hospitals) and the enhanced option (enhanced casebased data: 88%; microbiological data collection: 92%). The median times required for the minimal, light and enhanced protocols were 1.1, 2.0 and 3.0 person-days per 10 000 discharges, respectively [7].…”

“…The ECDC surveillance protocol for European surveillance of CDI derives from the protocol produced as part of the ECDC-funded 'European CDI Surveillance Network' (ECDIS-Net) project [7]. The protocol specifies three options for surveillance intensity: the 'minimal option' that only collects hospital-level aggregate numerators and denominators, the 'light option' that also collects case-based numerators including mortality, and the 'enhanced option' that also collects microbiological data on at least the first ten cases with a unique identifier linking the case-based data [11], (Table 1).…”

“…Of the 317 individuals for whom enhanced data were collected, 291 (92%) had a successful match of their microbiological and epidemiological data. Additionally, the coordinating laboratory could assign an RT to 268 (92%) of the 291 isolates collected from these individuals [7].…”

“…Many of the 24 national surveillance systems report data on only HA CDI, even though CA CDI and 'unknown origin' CDI constituted 16% of CDIs detected in hospitalized patients during the pilot survey of European CDI surveillance in 2013 [7]. National surveillance systems in the Netherlands and Hungary changed in 2011 and 2015, respectively, to provide data on the origin of CDI cases in hospitalized patients, rather than solely reporting data on HA CDI.…”