The Need for European Surveillance of CDI

  • Camilla Wiuff
  • A-Lan Banks
  • Fidelma Fitzpatrick
  • Laura Cottom
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1050)

Abstract

Since the turn of the millennium, the epidemiology of Clostridium difficile infection (CDI) has continued to challenge. Over the last decade there has been a growing awareness that improvements to surveillance are needed. The increasing rate of CDI and emergence of ribotype 027 precipitated the implementation of mandatory national surveillance of CDI in the UK. Changes in clinical presentation, severity of disease, descriptions of new risk factors and the occurrence of outbreaks all emphasised the importance of early diagnosis and surveillance.

However a lack of consensus on case definitions, clinical guidelines and optimal laboratory diagnostics across Europe has lead to the underestimation of CDI and impeded comparison between countries. These inconsistencies have prevented the true burden of disease from being appreciated.

Acceptance that a multi-country surveillance programme and optimised diagnostic strategies are required not only to detect and control CDI in Europe, but for a better understanding of the epidemiology, has built the foundations for a more robust, unified surveillance. The concerted efforts of the European Centre for Disease Prevention and Control (ECDC) CDI networks, has lead to the development of an over-arching long-term CDI surveillance strategy for 2014–2020. Fulfilment of the ECDC priorities and targets will no doubt be challenging and will require significant investment however the hope is that both a national and Europe-wide picture of CDI will finally be realised.

Keywords

Surveillance Epidemiology Standardisation Capacity building Collaborative effort 

References

  1. Alcala L, Martin A, Marin M et al (2012) The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? Clin Microbiol Infect 18(7):E204–E213.  https://doi.org/10.1111/j.1469-0691.2012.03883.x CrossRefPubMedPubMedCentralGoogle Scholar
  2. Barbut F, Corthier G, Charpak Y et al (1996) Prevalence and pathogenicity of Clostridium difficile in hospitalized patients. A French multicenter study. Arch Intern Med 156(13):1449–1454CrossRefPubMedCentralGoogle Scholar
  3. Barbut F, Delmee M, Brazier JS et al (2003) A European survey of diagnostic methods and testing protocols for Clostridium difficile. Clin Microbiol Infect 9(10):989–996CrossRefPubMedCentralGoogle Scholar
  4. Barbut F, Mastrantonio P, Delmee M et al (2007) Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clin Microbiol Infect 13(11):1048–1057.  https://doi.org/10.1111/j.1469-0691.2007.01824.x CrossRefPubMedPubMedCentralGoogle Scholar
  5. Bauer MP, Veenendaal D, Verhoef L et al (2009) Clinical and microbiological characteristics of community-onset Clostridium difficile infection in The Netherlands. Clin Microbiol Infect 15(12):1087–1092.  https://doi.org/10.1111/j.1469-0691.2009.02853.x CrossRefPubMedPubMedCentralGoogle Scholar
  6. Bauer MP, Notermans DW, Van Benthem BH et al (2011) Clostridium difficile infection in Europe: a hospital-based survey. Lancet 377(9759):63–73.  https://doi.org/10.1016/s0140-6736(10)61266-4 CrossRefPubMedPubMedCentralGoogle Scholar
  7. Cassini A, Plachouras D, Eckmanns T et al (2016) Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 13(10):e1002150.  https://doi.org/10.1371/journal.pmed.1002150 CrossRefPubMedPubMedCentralGoogle Scholar
  8. Davies KA, Longshaw CM, Davis GL et al (2014) Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis 14(12):1208–1219.  https://doi.org/10.1016/S1473-3099(14)70991-0 CrossRefPubMedPubMedCentralGoogle Scholar
  9. Delmee M (2001) Laboratory diagnosis of Clostridium difficile disease. Clin Microbiol Infect 7(8):411–416CrossRefPubMedCentralGoogle Scholar
  10. Duerden BI (2011) Contribution of a government target to controlling Clostridium difficile in the NHS in England. Anaerobe 17(4):175–179.  https://doi.org/10.1016/j.anaerobe.2010.12.004 CrossRefPubMedPubMedCentralGoogle Scholar
  11. Department of Health and Health Protection Agency (2008) Clostridium difficile infection: how to deal with the problemGoogle Scholar
  12. ECDC (2013a) European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. StockholmGoogle Scholar
  13. ECDC (2013b) European Centre for Disease Prevention and Control. Long-term surveillance strategy 2014–2020. StockholmGoogle Scholar
  14. ECDC (2017) European centre for disease prevention and control. European surveillance of Clostridium difficile infections. Surveillance protocol version 2.3. StockholmGoogle Scholar
  15. Eyre DW, Walker AS (2013) Clostridium difficile surveillance: harnessing new technologies to control transmission. Expert Rev Anti-Infect Ther 11(11):1193–1205.  https://doi.org/10.1586/14787210.2013.845987 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Eyre DW, Fawley WN, Best EL et al (2013) Comparison of multilocus variable-number tandem-repeat analysis and whole-genome sequencing for investigation of Clostridium difficile transmission. J Clin Microbiol 51(12):4141–4149.  https://doi.org/10.1128/JCM.01095-13 CrossRefPubMedPubMedCentralGoogle Scholar
  17. Fawley WN, Wilcox MH, Clostridium difficile Ribotyping Network for E et al (2011) An enhanced DNA fingerprinting service to investigate potential Clostridium difficile infection case clusters sharing the same PCR ribotype. J Clin Microbiol 49(12):4333–4337.  https://doi.org/10.1128/JCM.05873-11 CrossRefPubMedPubMedCentralGoogle Scholar
  18. Freeman J, Bauer MP, Baines SD et al (2010) The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 23(3):529–549.  https://doi.org/10.1128/CMR.00082-09 CrossRefPubMedCentralGoogle Scholar
  19. Goorhuis A, Bakker D, Corver J et al (2008) Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis 47(9):1162–1170.  https://doi.org/10.1086/592257 CrossRefPubMedPubMedCentralGoogle Scholar
  20. He M, Miyajima F, Roberts P et al (2013) Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet 45(1):109–113.  https://doi.org/10.1038/ng.2478 CrossRefPubMedPubMedCentralGoogle Scholar
  21. Healthcare Commission (2006) Investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital. Trust, Buckinghamshire Hospitals NHSGoogle Scholar
  22. Health Protection Scotland (2006) CDI background. http://www.hps.scot.nhs.uk/resourcedocument.aspx?resourceid=1446
  23. Health Protection Scotland (2009) Guidance on Prevention and Control of Clostridium difficile Infection (CDI) in Healthcare Settings in Scotland. Health Protection Network Scottish Guidance 6. Health Protection Scotland. http://www.processcleaningsolutions.com/pdf/clostridium-difficile-infection-guidelines%20Scotland.pdf
  24. Health Protection Scotland (2010) The annual surveillance of healthcare associated infection report January – December 2009. http://www.documents.hps.scot.nhs.uk/hai/annual-report/annual-surveillance-haireport-2009.pdf
  25. Health Protection Scotland (2012) The annual surveillance of healthcare associated infections report. January–December 2011. http://www.documents.hps.scot.nhs.uk/hai/annual-report/annual-surveillance-haireport-2011.pdf
  26. Health Protection Scotland (2014) Prevention and Control of Clostridium difficile (CDI) in care settings in Scotland. 2.1Google Scholar
  27. Kelly CP, LaMont JT (1998) Clostridium difficile infection. Annu Rev Med 49:375–390.  https://doi.org/10.1146/annurev.med.49.1.375 CrossRefPubMedPubMedCentralGoogle Scholar
  28. Kola A, Wiuff C, Akerlund T et al (2016) Survey of Clostridium difficile infection surveillance systems in Europe, 2011. Euro Surveill 21(29).  https://doi.org/10.2807/1560-7917.es.2016.21.29.30291
  29. Kuijper EJ, Coignard B, Tull P (2006) Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 12(6):2–18.  https://doi.org/10.1111/j.1469-0691.2006.01580.x CrossRefPubMedCentralGoogle Scholar
  30. Kuijper EJ, Coignard B, Brazier JS et al (2007) Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill 12(6):E1–E2CrossRefPubMedCentralGoogle Scholar
  31. Kuijper EJ, Barbut F, Brazier JS et al (2008) Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill 13(31):pii: 18942Google Scholar
  32. Lawes T, Lopez-Lozano JM, Nebot CA et al (2017) Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: anon-linear time-series analysis. Lancet Infect Dis 17(2):194–206.  https://doi.org/10.1016/S1473-3099(16)30397-8 CrossRefPubMedPubMedCentralGoogle Scholar
  33. McDonald LC, Coignard B, Dubberke E et al (2007) Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 28(2):140–145.  https://doi.org/10.1086/511798 CrossRefPubMedPubMedCentralGoogle Scholar
  34. Nathwani D, Sneddon J, Malcolm W et al (2011) Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents 38(1):16–26.  https://doi.org/10.1016/j.ijantimicag.2011.02.005 CrossRefPubMedPubMedCentralGoogle Scholar
  35. Pearson A (2009) Historical and changing epidemiology of healthcare-associated infections. J Hosp Infect 73(4):296–304.  https://doi.org/10.1016/j.jhin.2009.08.016 CrossRefPubMedPubMedCentralGoogle Scholar
  36. Ricciardi R, Rothenberger DA, Madoff RD et al (2007) Increasing prevalence and severity of Clostridium difficile colitis in hospitalized patients in the United States. Arch Surg 142(7):624–631.  https://doi.org/10.1001/archsurg.142.7.624. discussion 631CrossRefPubMedPubMedCentralGoogle Scholar
  37. Scottish Government (2012) NHSScotland local delivery plan guidance 2013/14Google Scholar
  38. The Vale of Leven Hospital Inquiry (2014) The Vale of Leven Hospital inquiry report. The Rt Hon Lord MacLeanGoogle Scholar
  39. van Dorp SM, Kinross P, Gastmeier P et al (2016a) Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013. Euro Surveill 21(29).  https://doi.org/10.2807/1560-7917.es.2016.21.29.30293
  40. van Dorp SM, Notermans DW, Alblas J et al (2016b) Survey of diagnostic and typing capacity for Clostridium difficile infection in Europe, 2011 and 2014. Euro Surveill 21(29).  https://doi.org/10.2807/1560-7917.es.2016.21.29.30292
  41. Vonberg RP, Kuijper EJ, Wilcox MH et al (2008) Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Infect 14(Suppl 5):2–20.  https://doi.org/10.1111/j.1469-0691.2008.01992.x CrossRefPubMedPubMedCentralGoogle Scholar
  42. Warny M, Pepin J, Fang A et al (2005) Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 366(9491):1079–1084.  https://doi.org/10.1016/S0140-6736(05)67420-X CrossRefPubMedPubMedCentralGoogle Scholar
  43. Wilcox MH, Mooney L, Bendall R et al (2008) A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother 62(2):388–396.  https://doi.org/10.1093/jac/dkn163 CrossRefPubMedPubMedCentralGoogle Scholar
  44. Wilcox MH, Shetty N, Fawley WN et al (2012) Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis 55(8):1056–1063.  https://doi.org/10.1093/cid/cis614 CrossRefPubMedPubMedCentralGoogle Scholar
  45. Wiuff C, Brown DJ, Mather H et al (2011) The epidemiology of Clostridium difficile in Scotland. J Inf Secur 62(4):271–279.  https://doi.org/10.1016/j.jinf.2011.01.015 CrossRefGoogle Scholar
  46. Wiuff C, Banks A, Brown DJ, Henderson D,Coia JE, Inkster T (2014) The changing epidemiology of Clostridium difficile ribotypes in Scotland between 2009 and 2013. Paper presented at the European Congress on Clinical Microbiology and Infectious Diseases, 2014, BarcelonaGoogle Scholar
  47. World Bank (2017) GNI (nominal) per capita for year 2016, World Development Indicators database, Atlas method, World Bank, revised 01 July 2017Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Camilla Wiuff
    • 1
  • A-Lan Banks
    • 1
  • Fidelma Fitzpatrick
    • 2
    • 3
  • Laura Cottom
    • 4
  1. 1.Strategic Lead Microbiology, NHS National Services Scotland, Health Protection Scotland, HAI & IC SectionGlasgowUK
  2. 2.Department of Clinical MicrobiologyThe Royal College of Surgeons in IrelandDublinIreland
  3. 3.Department of Clinical MicrobiologyBeaumont HospitalDublinIreland
  4. 4.Department of MicrobiologyGlasgow Royal InfirmaryGlasgowUK

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