Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Davies, Kerrie A.; Longshaw, Christopher; Davis, Georgina; Bouza, Emilio; Barbut, Frédéric; Barna, Z; Delmée, Michel; Fitzpatrick, Fidelma; Ivanova, K.; Kuijper, Ed J.; Macovei, Ioana; Mentula, Silja; Mastrantonio, Paola; Müller, Lutz von; Oleastro, Mónica; Petinaki, Efthymia; Pituch, Hanna; Norén, Torbjörn; Nováková, Elena; Nyč, Otakar; Rupnik, Maja; Schmid, Daniela; Wilcox, Mark H.

doi:10.1016/s1473-3099(14)70991-0

Cited by 342 publications

(370 citation statements)

References 25 publications

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“…Such information is important as the emergence of variant strains complicates diagnostic testing and may contribute to the underdiagnosis of CDI observed in previous largescale studies (Davies et al, 2014). The poor performance of toxin-based EIA tests favours a change to PCR-based testing strategies for local clinicians.…”

Section: Discussionmentioning

confidence: 99%

A comparison of Clostridium difficile diagnostic methods for identification of local strains in a South African centre

Rajabally

Kullin

Ebrahim

et al. 2016

Journal of Medical Microbiology

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Accurate diagnosis of Clostridium difficile infection is essential for disease management.A clinical and molecular analysis of C. difficile isolated from symptomatic patients at Groote Schuur Hospital, South Africa, was conducted to establish the most suitable clinical test for the diagnosis and characterization of locally prevalent strains. C. difficile was detected in stool samples using enzyme-based immunoassays (EIA) and nucleic acid amplification methods, and their performance was compared with that of C. difficile isolation using direct selective culture combined with specific PCR to detect the C. difficile tpi gene, toxin A and B genes and binary toxin genes. Toxigenic isolates were characterized further by ribotyping. Selective culture isolated 32 C. difficile strains from 145 patients (22 %). Of these, the most prevalent (50 %) were of ribotype 017 (toxin A 2 B + ) while 15.6 % were ribotype 001 (toxin A + B + ). No ribotype 027 strains or binary toxin genes (cdtA and cdtB) were detected. The test sensitivities and specificities, respectively, of four commercial clinical diagnostic methods were as follows: ImmunoCard Toxins A & B (40 % and 99.1 %), VIDAS C. difficile Toxin A & B (50 % and 99.1 %), GenoType CDiff (86.7 % and 88.3 %) and Xpert C. difficile (90 % and 97.3 %). Ribotype 001 and 017 strains had a 100 % detection rate by Xpert C. difficile, 100 % and 93.3 % by GenoType CDiff, 75 % and 53.3 % by ImmunoCard and 75 % and 60 % by VIDAS, respectively. The overall poor performance of EIA suggests that a change to PCR-based testing would assist diagnosis and ensure reliable detection of locally prevalent C. difficile 017 strains. INTRODUCTIONOver the last decade, Clostridium difficile infection (CDI) has emerged as an important healthcare problem, both in the hospital setting and in the community. There has been growing concern over its rising incidence, disease severity and mortality. Major epidemics, causing significant loss of lives, have been reported in North America and Europe (Birgand et al., 2010; Healthcare Commission, 2006; Pépin et al., 2004). These epidemics have been attributed to virulent strains capable of producing more than ten times the amount of toxins than conventional strains (Kelly & LaMont, 2008;McDonald et al., 2005;O'Connor et al., 2009). In addition, the 'hyper virulent' 027 strain has developed resistance to antibiotics such as fluoroquinolones (Pépin et al., 2005).In South Africa, information on CDI remains scarce. Yet, there are some studies that have shown that CDI in this Abbreviations: CA, community acquired; CDI, Clostridium difficile infection; EIA, enzyme-based immunoassays; GDH, glutamate dehydrogenase; HA, hospital acquired; NLR, negative likelihood ratio; NPV, negative predictive value; PLR, positive likelihood ratio; PPV, positive predictive value. part of the world is not insignificant. In 2008, an institution in Pretoria reported a sudden increase in toxin-producing C. difficile, raising the alert of a possible outbreak and sensitizing its clinicians (Lekala...

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Section: Discussionmentioning

confidence: 99%

A comparison of Clostridium difficile diagnostic methods for identification of local strains in a South African centre

Rajabally

Kullin

Ebrahim

et al. 2016

Journal of Medical Microbiology

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“…Results from the second study -involving 20 European countries -revealed an increasing CDI incidence rate in the Czech Republic (4.4 cases in 2011-12/10,000 patient bed-days and 6.2 cases/10,000 patient beddays in 2012-13) [2].…”

Section: Introductionmentioning

confidence: 96%

“…Two large studies have been carried out to map and update data on C. difficile infection (CDI) in Europe [1,2]. CDI incidence showed an increasing trend: in the first study in 2008, the mean incidence in the participating countries was 4.1 cases per 10,000 patient bed-days [1], while in the second, in 2011-13, it was 7.0 CDI cases per 10, 000 patient bed-days in the countries involved [2].…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile PCR ribotypes 001 and 176 – the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014

et al. 2016

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In 2014, 18 hospitals in the Czech Republic participated in a survey of the incidence of Clostridium difficile infections (CDI) in the country. The mean CDI incidence was 6.1 (standard deviation (SD):7.2) cases per 10,000 patient bed-days and 37.8 cases (SD: 41.4) per 10,000 admissions. The mean CDI testing frequency was 39.5 tests (SD: 25.4) per 10,000 patient bed-days and 255.8 tests (SD: 164.0) per 10,000 admissions. A total of 774 C. difficile isolates were investigated, of which 225 (29%) belonged to PCR ribotype 176, and 184 isolates (24%) belonged to PCR ribotype 001. Multilocus variable-number tandem repeat analysis (MLVA) revealed 27 clonal complexes formed by 84% (190/225) of PCR ribotype 176 isolates, and 14 clonal complexes formed by 77% (141/184) of PCR ribotype 001 isolates. Clonal clusters of PCR ribotypes 176 and 001 were observed in 11 and 7 hospitals, respectively. Our data demonstrate the spread of two C. difficile PCR ribotypes within 18 hospitals in the Czech Republic, stressing the importance of standardising CDI testing protocols and implementing mandatory CDI surveillance in the country.

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Section: Diagnosis and Preventionmentioning

confidence: 99%

“…1 Furthermore, it has to be noted that occurrence of CDI is often underestimate due to inadequacy of standardizes testing and lack of clinical suspicion. 1 Occurrence and spreading of CDI can be significantly limited by introduction of prevention measures. The most important elements are early recognition of CDI in patients with known risk factors, use of appropriate diagnostic tests and communication to the staff members of positive cases.…”

Section: Diagnosis and Preventionmentioning

confidence: 99%

Prevention and treatment of Clostridium difficile infection

et al. 2017

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Clostridium difficile infection (CDI) is one of the most common intestinal infection often requiring hospitalization. Several risk factors are associated with the development of CDI with antibiotic treatments being the most common. Diagnosis is based on clinical suspicion, (typical symptoms associated with risk factors) and confirmatory tests, both of which are often inadequate leading to underestimation of the disease.

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Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

Abstract: Background: Variations in testing for Clostridium difficile infection (CDI) may hinder patient care, increase

Cited by 342 publications

References 25 publications

A comparison of Clostridium difficile diagnostic methods for identification of local strains in a South African centre

A comparison of Clostridium difficile diagnostic methods for identification of local strains in a South African centre

Clostridium difficile PCR ribotypes 001 and 176 – the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014

Prevention and treatment of Clostridium difficile infection

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