Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID)

被引:270
作者
Davies, Kerrie A. [1 ]
Longshaw, Christopher M. [2 ]
Davis, Georgina L. [1 ]
Bouza, Emilio [3 ]
Barbut, Frederic [4 ]
Barna, Zsuzsanna [5 ]
Delmee, Michel [6 ]
Fitzpatrick, Fidelma [7 ,8 ]
Ivanova, Kate [9 ]
Kuijper, Ed [10 ]
Macovei, Ioana S. [11 ]
Mentula, Silja [12 ]
Mastrantonio, Paola [13 ]
von Mueller, Lutz [14 ]
Oleastro, Monica [15 ]
Petinaki, Efthymia [16 ]
Pituch, Hanna [17 ]
Noren, Torbjorn [18 ]
Novakova, Elena [19 ]
Nyc, Otakar [20 ]
Rupnik, Maja [21 ,22 ]
Schmid, Daniela [23 ]
Wilcox, Mark H. [1 ]
机构
[1] Univ Leeds, EUCLID European Coordinators, Leeds, W Yorkshire, England
[2] Astellas Pharma Europe, Chertsey, England
[3] Univ Gregorio Maranon, Gen Hosp, Microbiol Clin E Infecc, Catedrat Jefe Serv, Madrid, Spain
[4] Univ Paris 06, Natl Reference Lab Clostridium Difficile, Paris, France
[5] Natl Ctr Epidemiol, Dept Bacteriol, Budapest, Hungary
[6] Catholic Univ Louvain, IREC, B-1200 Brussels, Belgium
[7] Hlth Protect Surveillance Ctr, Dublin, Ireland
[8] Beaumont Hosp, Dublin 9, Ireland
[9] Natl Ctr Infect & Parasit Dis, Sofia, Bulgaria
[10] Leiden Univ, Med Ctr, Dept Med Microbiol, Leiden, Netherlands
[11] Cantacuzino Natl Inst Res & Dev Microbiol & Immun, Bucharest, Romania
[12] Natl Inst Hlth & Welf THL, Bacteriol Unit, Helsinki, Finland
[13] Ist Super Sanita, Dept Infect Dis, I-00161 Rome, Italy
[14] Univ Saarland, Med Ctr, Inst Med Microbiol & Hyg, Homburg, Germany
[15] Natl Inst Hlth Dr Ricardo Jorge, Dept Infect Dis, Lisbon, Portugal
[16] Univ Thessalia, Univ Hosp, Sch Med, Larisa, Greece
[17] Med Univ Warsaw, Dept Med Microbiol, Warsaw, Poland
[18] Orebro Univ Hosp, Orebro, Sweden
[19] Comenius Univ, Jessenius Fac Med Martin, Martin, TN, Slovakia
[20] Univ Hosp Motol, Dept Med Microbiol, Prague, Czech Republic
[21] Univ Maribor, Fac Med, SLO-2000 Maribor, Slovenia
[22] Natl Lab Hlth Environm & Food NLZOH, Maribor, Slovenia
[23] Austrian Agcy Hlth & Food Safety, Inst Med Microbiol & Hyg, Vienna, Austria
关键词
CHANGING EPIDEMIOLOGY; ECONOMIC BURDEN; IMPACT; RATES;
D O I
10.1016/S1473-3099(14)70991-0
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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.
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收藏
页码:1208 / 1219
页数:12
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