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. 2022 Jun;27(26):2100704.
doi: 10.2807/1560-7917.ES.2022.27.26.2100704.

A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018

Virginie F Viprey  1 , Georgina L Davis  1 , Anthony D Benson  1 , Duncan Ewin  1 , William Spittal  1 , Jon J Vernon  1 , Maja Rupnik  2   3   4 , Alice Banz  5 , Florence Allantaz  5 , Philippe Cleuziat  5 ; COMBACTE-CDI National Coordinators  6 ; Mark H Wilcox  1   4   7 , Kerrie A Davies  1   4   7 ; COMBACTE-CDI consortium  8 ; Members of the COMBACTE-CDI National coordinators
Collaborators, Affiliations

A point-prevalence study on community and inpatient Clostridioides difficile infections (CDI): results from Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI), July to November 2018

Virginie F Viprey et al. Euro Surveill. 2022 Jun.

Abstract

BackgroundThere is a paucity of data on community-based Clostridioides difficile infection (CDI) and how these compare with inpatient CDI.AimTo compare data on the populations with CDI in hospitals vs the community across 12 European countries.MethodsFor this point-prevalence study (July-November 2018), testing sites sent residual diagnostic material on sampling days to a coordinating laboratory for CDI testing and PCR ribotyping (n = 3,163). Information on whether CDI testing was requested at the original site was used to identify undiagnosed CDI. We used medical records to identify differences between healthcare settings in patient demographics and risk factors for detection of C. difficile with or without free toxin.ResultsThe CDI positivity rate was 4.4% (country range: 0-16.2) in hospital samples, and 1.3% (country range: 0-2.2%) in community samples. The highest prevalence of toxinotype IIIb (027, 181 and 176) was seen in eastern European countries (56%; 43/77), the region with the lowest testing rate (58%; 164/281). Different predisposing risk factors were observed (use of broad-spectrum penicillins in the community (OR: 8.09 (1.9-35.6), p = 0.01); fluoroquinolones/cephalosporins in hospitals (OR: 2.2 (1.2-4.3), p = 0.01; OR: 2.0 (1.1-3.7), p = 0.02)). Half of community CDI cases were undetected because of absence of clinical suspicion, accounting for three times more undiagnosed adults in the community compared with hospitals (ca 111,000 vs 37,000 cases/year in Europe).ConclusionThese findings support recommendations for improving diagnosis in patients presenting with diarrhoea in the community, to guide good practice to limit the spread of CDI.

Keywords: Clostridioides difficile; community; diagnosis; hospital.

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Conflict of interest statement

Conflict of interest: AB, FA, and PC are employees of bioMérieux. The other authors have no conflict of interest to declare in relation to the submitted work. MR, MHW, and KAD received support outside the scope of the submitted work: MR reports personal fees from Ferring and GSK outside the submitted work. MHW reports grants and personal fees from Actelion, Alere, Astellas, Cubist, Da Volterra, Enterobiotix, European Tissue Symposium, Merck, Sanofi-Pasteur, Seres and Summit, personal fees from Astra-Zeneca, Basilea, Bayer, Durata, Idorsia, J and J, Menarini, Nabriva, Novacta, Novartis, Optimer, Pfizer and Roche, grants from Abbott, bioMérieux, Cerexa, The Medicines Company and Qiagen, outside the submitted work. KAD reports grants from Astellas Pharma Europe Ltd, Alere, bioMérieux, Cepheid, Pfizer and Sanofi-Pasteur, personal fees from Astellas Pharma Europe Ltd and Summit, outside the submitted work.

Figures

Figure 1
Figure 1
Sample flow-chart of the COMBACTE-CDI point-prevalence and follow-up study, 12 European countries, July–November 2018
Figure 2
Figure 2
Testing rate, prevalence of related ribotypes within toxinotype IIIb (027, 181 and 176) and Clostridioides difficile positivity rate in diarrhoeal faecal samples A. hospital and B. community locations across countries, by European region, July–November 2018 (n = 3,153)
Figure 3
Figure 3
Forest plot of odds ratio for previous exposure and co-morbidities, comparing outcome groups for Clostridioides difficile infections and control groups, by healthcare settings, Europe, 2018 (n = 615)
See this image and copyright information in PMC

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