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. 2023 Apr;12(4):1057-1072.
doi: 10.1007/s40121-023-00785-2. Epub 2023 Mar 10.

Epidemiology of Clostridioides difficile Infections in Germany, 2010-2019: A Review from Four Public Databases

Gordon Brestrich  1 , Frederick J Angulo  2 , Fabian K Berger  3   4 , Christian Brösamle  5 , Stefan Hagel  6 , Andreas Leischker  7 , Christoph Lübbert  8   9   10 , Friederike Maechler  11   12 , Sophie-Susann Merbecks  13 , Nadia Minarovic  14 , Jennifer C Moïsi  14 , Lutz von Müller  4   15 , Phillip A Reuken  16 , Thomas Weinke  17 , Holly Yu  18 , Alexander Mellmann  4   19
Affiliations

Epidemiology of Clostridioides difficile Infections in Germany, 2010-2019: A Review from Four Public Databases

Gordon Brestrich et al. Infect Dis Ther. 2023 Apr.

Abstract

Introduction: Clostridioides difficile infection (CDI) is a recognized global threat especially for vulnerable populations. It is of particular concern to healthcare providers as it is found in both hospital and community settings, with severe courses, frequent recurrence, high mortality and substantial financial impact on the healthcare system. The CDI burden in Germany has been described and compared by analysing data from four different public databases.

Methods: Data on hospital burden of CDI have been extracted, compared, and discussed from four public databases for the years 2010-2019. Hospital days due to CDI were compared to established vaccine preventable diseases, such as influenza and herpes zoster, and also to CDI hospitalisations in the United States (US).

Results: All four databases reported comparable incidences and trends. Beginning in 2010, population-based hospitalised CDI incidence increased to a peak of > 137/100,000 in 2013. Then, incidence declined to 81/100,000 in 2019. Hospitalised patients with CDI were predominantly > 50 years of age. The population-based incidence of severe CDI was between 1.4 and 8.4/100,000 per year. Recurrence rates were between 5.9 to 6.5%. More than 1,000 CDI deaths occurred each year, with a peak of 2,666 deaths in 2015. Cumulative CDI patient days (PD) were between 204,596 and 355,466 each year, which exceeded cumulated PD for influenza and herpes zoster in most years, though year-to-year differences were observed. Finally, hospitalized CDI incidence was higher in Germany than in the US, where the disease is well recognized as a public health threat.

Conclusions: All four public sources documented a decline in CDI cases since 2013, but the disease burden remains substantial and warrants continued attention as a severe public health challenge.

Keywords: Burden of disease; Clostridioides difficile; Germany; Hospital; Incidence; Surveillance.

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Conflict of interest statement

Stefan Hagel reports grants from the Federal Ministry of Education and Research (BMBF), lecture fees from Pfizer, MSD, InfectoPharm, Advanz, Tillotts and Philips, support for attending meetings from Pfizer and Advanz. Christoph Lübbert reports lecture and consulting fees from Tillots. Phillip A. Reuken reports lecture or consulting fees from Pfizer, CSL Behring, BMS and Dr. Schwabe Pharma. Fabian K. Berger reports consultant fees from Pfizer, MSD and research support from Tillots. Thomas Weinke reports lecture or consulting fees from BioNTech, Falk Foundation, GSK, MSD, Pfizer, Roche, Sanofi Pasteur and Seqirus. Gordon Brestrich, Frederick J. Angulo, Christian Brösamle, Stefan Hagel, Andreas Leischker, Friederike Maechler, Sophie-Susann Merbecks, Nadia Minarovic, Jennifer C. Moïsi, Lutz von Mueller Holly Yu and Alexander Mellman declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trends of hospitalised CDI cases/100.0000 population/year from the three German surveillance systems RKIa, LUAb, CDAD-KISS, the German GBE-Bund database and the US CDC Emerging Infections Program. CDI Clostridioides difficile infection; CDAD-KISS Hospital Infection Surveillance System; GBE-Bund Information System of the Federal Health Monitoring; LUA Saxon State Health and Veterinary Research Institute Saxony; RKI Robert Koch-Institute, US CDC EIP US Centers for Disease Control and Prevention Emerging Infections Program, aincludes severe cases only, balso includes non-hospitalized cases
Fig. 2
Fig. 2
Age-stratification of CDI-related deaths 2010–2019 including nosocomial and community-acquired CDI cases (source: GBE-Bund)
Fig. 3
Fig. 3
CDI-related overall PD compared to PD for influenza (ICD-10 J09 and J10) and herpes zoster (ICD-10 B02) per year 2010–2019 (source: GBE-Bund). CDI Clostridioides difficile infection; PD patient days
See this image and copyright information in PMC

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