Abstract
Clostridium difficile infection (CDI) is the major cause of infective diarrhoea in healthcare environments. As part of the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID), the largest C. difficile epidemiological study of its type, PCR ribotype distribution of C. difficile isolates in Europe was investigated. PCR ribotyping was performed on 1,196 C. difficile isolates from diarrhoeal samples sent to the European coordinating laboratory in 2012-13 and 2013 (from two sampling days) by 482 participating hospitals from 19 European countries. A total of 125 ribotypes were identified, of which ribotypes 027 (19%, n =222), 001/072 (11%, n = 134) and 014/020 (10%, n = 119) were the most prevalent. Distinct regional patterns of ribotype distribution were noted. Of 596 isolates from patients with toxin-positive stools (CDI cases), ribotype 027 accounted for 22% (32/144) of infections in cases aged from 18 to less than 65 years, but the prevalence decreased in those aged ≥ 65 years (14% (59/412)) and further decreased in those aged ≥ 81 years (9% (18/195)). The prevalence of ribotype 027 and 176, but not other epidemic strains, was inversely proportional to overall ribotype diversity (R(2) = 0.717). This study highlights an increased diversity of C. difficile ribotypes across Europe compared with previous studies, with considerable intercountry variation in ribotype distribution. Continuous surveillance programmes are necessary to monitor the changing epidemiology of C. difficile.
Highlights
Clostridium difficile is the most common cause of infective diarrhoea in hospitalised patients, and is www.eurosurveillance.org associated with substantial morbidity and mortality.Over the past decade, the burden of C. difficile infection (CDI) has increased in many European countries, with the annual incidence in Europe estimated at124,000 cases in 2011–12 [1] with all-cause mortality rates of 3–30% [2,3,4,5]
C. difficile types has intensified the challenge of Clostridium difficile infection (CDI)
Given that most ribotype 027 strains were found to be localised mainly to four countries (Germany, Hungary, Poland and Romania) [12], we investigated the relationship between prevalence of ribotype 027 in the countries in which it was identified in EUCLID and the overall ribotype diversity among all C. difficile isolates received during the study from those countries
Summary
Clostridium difficile is the most common cause of infective diarrhoea in hospitalised patients, and is www.eurosurveillance.org associated with substantial morbidity and mortality.Over the past decade, the burden of C. difficile infection (CDI) has increased in many European countries, with the annual incidence in Europe estimated at124,000 cases in 2011–12 [1] with all-cause mortality rates of 3–30% [2,3,4,5]. Clostridium difficile is the most common cause of infective diarrhoea in hospitalised patients, and is www.eurosurveillance.org associated with substantial morbidity and mortality. The burden of C. difficile infection (CDI) has increased in many European countries, with the annual incidence in Europe estimated at. 124,000 cases in 2011–12 [1] with all-cause mortality rates of 3–30% [2,3,4,5]. CDI continues to be the focus of comprehensive national-level control and surveillance programmes in some countries, but the public health threat of CDI is not yet fully recognised across Europe. C. difficile types has intensified the challenge of CDI. In the 1990s, strains belonging to PCR ribotype 027
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