The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem?

Clin Microbiol Infect 2012; 18: E204E213 Abstract Underdiagnosis of Clostridium difficile infection (CDI) because of lack of clinical suspicion or the use of non-sensitive diagnostic techniques is a known problem whose real magnitude has not yet been quantified. In order to estimate the extent of this underdiagnosis, we performed C.similar to difficile cultures on all unformed stool specimens sentirrespective of the type of requestto a series of laboratories in Spain on a single day. The specimens were cultured, and isolates were characterized at a central reference laboratory. A total of 807 specimens from 730 patients aged =2 similar to years were selected from 118 laboratories covering 75.4% of the Spanish population. The estimated rate of hospital-acquired CDI was 2.4 similar to episodes per 1000 similar to admissions or 3.8 similar to episodes per 10 000 similar to patient-days. Only half of the episodes occurred in patients hospitalized for >2 similar to days. Two of every three episodes went undiagnosed or were misdiagnosed, owing to non-sensitive diagnostic tests (19.0%) or lack of clinical suspicion and request (47.6%; mostly young people or non-hospitalized patients). The main ribotypes were 014/020 (20.5%), 001 (18.2%), and 126/078 (18.2%). No ribotype similar to 027 strains were detected. Strains were fully susceptible to metronidazole and vancomycin. CDI was underdiagnosed in diarrhoeic stools in a high proportion of episodes, owing to the use of non-sensitive techniques or lack of clinical suspicion, particularly in people aged <65 similar to years or patients with community-acquired diarrhoea. C.similar to difficile toxins should be routinely sought in unformed stools of any origin sent for microbiological diagnosis. The ribotype similar to 027 clone has not yet disseminated in Spain.