Abstract
Background Clostridioides difficile is a leading cause of healthcare-associated diarrhoea in middle and high-income countries. Up to 2018, there has been no systematic, annual surveillance for C. difficile infections (CDI) in France.AimsTo provide an updated overview of the epidemiology of CDI in France between 2010 and 2017 based on five different data sources.MethodsThis is a descriptive study of retrospective surveillance and alerts data. Incidence of CDI cases was estimated through the CDI incidence survey (2016) and data from the French National Uniform Hospital Discharge Database (PMSI; 2010–16). Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). The national early warning response system for HAI (HAI-EWRS, 2012–17) and National Reference Laboratory data (2012–17) were used to follow the number of severe CDI cases and/or outbreaks.ResultsIn 2016, CDI incidence in acute care was 3.6 cases per 10,000 patient days (PD). There was a statistically significant increase in CDI incidence between 2010 and 2016 (+ 14% annually) and testing frequency was 47.4 per 10,000 PD. The number of CDI HAI-EWRS notifications decreased between 2015 and 2017 with only a few large outbreaks reported.ConclusionThe CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence.
Highlights
Clostridium difficile, officially renamed Clostridioides difficile in 2016, is responsible for 15–25% of antibioticassociated diarrhoea cases [1,2] and is considered the leading cause of healthcare-associated diarrhoea in developed countries
The aim of this study is to provide an updated overview of the epidemiology of C. difficile infections (CDI) in France based on these five different data sources: (i) the 2016 CDI incidence survey, (ii) the 2012 and 2017 point prevalence study (PPS), (iii) PMSI data, 2010–16, (iv) healthcare-associated infections (HAI)-EWRS notifications, 2012–17 and, (v) NRL data, 2012–17
Source of information Between April and June 2016, all laboratories within acute healthcare facilities (HCF) in France were asked to complete an optional questionnaire including questions on: (i) algorithms used for CDI diagnosis, (ii) number of stool specimens tested for C. difficile, (iii) number of stool specimens that tested positive for CDI, and (iv) number of CDI cases and number of hospital-acquired CDI cases (HA CDI cases) for acute care wards within acute HCF
Summary
Clostridium difficile, officially renamed Clostridioides difficile in 2016, is responsible for 15–25% of antibioticassociated diarrhoea cases [1,2] and is considered the leading cause of healthcare-associated diarrhoea in developed countries. In 2009, following the epidemic period, a national prospective, multicentric survey to assess CDI incidence and to characterise CDI strains was launched in France (ICD-Raisin study). It showed an incidence of 2.28 CDI per 10,000 patient days (PD) in acute healthcare facilities (HCF) and 1.15 per 10,000 PD in long-term facilities [12]. Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). Conclusion: The CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence
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