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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)
Univ Leeds, EUCLID European Coordinators, Leeds, W Yorkshire, England..
Astellas Pharma Europe, Chertsey, England..
Univ Leeds, EUCLID European Coordinators, Leeds, W Yorkshire, England..
Univ Gregorio Maranon, Gen Hosp, Microbiol Clin E Infecc, Catedrat Jefe Serv, Madrid, Spain..ORCID iD: 0000-0001-6967-9267
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2014 (English)In: Lancet. Infectious diseases (Print), ISSN 1473-3099, E-ISSN 1474-4457, Vol. 14, no 12, 1208-1219 p.Article in journal (Refereed) Published
Abstract [en]

Background: Variations in testing for Clostridium difficile infection can hinder patients' care, increase the risk of transmission, and skew epidemiological data. We aimed to measure the underdiagnosis of C difficile infection across Europe.

Methods: We did a questionnaire-based study at 482 participating hospitals across 20 European countries. Hospitals were questioned about their methods and testing policy for C difficile infection during the periods September, 2011, to August, 2012, and September, 2012, to August, 2013. On one day in winter, 2012-13 (December, 2012, or January, 2013), and summer, 2013 (July or August), every hospital sent all diarrhoeal samples submitted to their microbiology laboratory to a national coordinating laboratory for standardised testing of C difficile infection. Our primary outcome measures were the rates of testing for and cases of C difficile infection per 10 000 patient bed-days. Results of local and national C difficile infection testing were compared with each other. If the result was positive at the national laboratory but negative at the local hospital, the result was classified as undiagnosed C difficile infection. We compared differences in proportions with the Mann-Whitney test, or McNemar's test if data were matched.

Findings: During the study period, participating hospitals reported a mean of 65.8 tests (country range 4. 6-223.3) for C difficile infection per 10 000 patient-bed days and a mean of 7.0 cases (country range 0.7-28.7) of C difficile infection per 10 000 patient-bed days. Only two-fifths of hospitals reported using optimum methods for testing of C difficile infection (defined by European guidelines), although the number of participating hospitals using optimum methods increased during the study period, from 152 (32%) of 468 in 2011-12 to 205 (48%) of 428 in 2012-13. Across all 482 European hospitals on the two sampling days, 148 (23%) of 641 samples positive for C difficile infection (as determined by the national laboratory) were not diagnosed by participating hospitals because of an absence of clinical suspicion, equating to about 74 missed diagnoses per day.

Interpretation: A wide variety of testing strategies for C difficile infection are used across Europe. Absence of clinical suspicion and suboptimum laboratory diagnostic methods mean that an estimated 40 000 inpatients with C difficile infection are potentially undiagnosed every year in 482 European hospitals.

Place, publisher, year, edition, pages
Elsevier, 2014. Vol. 14, no 12, 1208-1219 p.
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-56368DOI: 10.1016/S1473-3099(14)70991-0ISI: 000345720200033PubMedID: 25455988Scopus ID: 2-s2.0-84922693344OAI: oai:DiVA.org:oru-56368DiVA: diva2:1081900
Note

Funding Agency:

Astellas Pharmaceuticals Europe 

Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2017-03-15Bibliographically approved

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