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|Title: ||Clostridium difficile infection in Europe: a hospital-based survey|
|Authors: ||Bauer, MP|
van Benthem, BH
van Dissel, JT
|Keywords: ||Clostridium Difficile|
|Issue Date: ||Jan-2011|
|Citation: ||Lancet. 2011 Jan 1;377(9759):63-73|
|Abstract: ||BACKGROUND: Little is known about the extent of Clostridium difficile infection in Europe. Our aim was to obtain a more complete overview of C difficile infection in Europe and build capacity for diagnosis and surveillance.
METHODS: We set up a network of 106 laboratories in 34 European countries. In November, 2008, one to six hospitals per country, relative to population size, tested stool samples of patients with suspected C difficile infection or diarrhoea that developed 3 or more days after hospital admission. A case was defined when, subsequently, toxins were identified in stool samples. Detailed clinical data and stool isolates were collected for the first ten cases per hospital. After 3 months, clinical data were followed up.
FINDINGS: The incidence of C difficile infection varied across hospitals (weighted mean 4·1 per 10,000 patient-days per hospital, range 0·0-36·3). Detailed information was obtained for 509 patients. For 389 of these patients, isolates were available for characterisation. 65 different PCR ribotypes were identified, of which 014/020 (61 patients [16%]), 001 (37 [9%]), and 078 (31 [8%]) were the most prevalent. The prevalence of PCR-ribotype 027 was 5%. Most patients had a previously identified risk profile of old age, comorbidity, and recent antibiotic use. At follow up, 101 (22%) of 455 patients had died, and C difficile infection played a part in 40 (40%) of deaths. After adjustment for potential confounders, an age of 65 years or older (adjusted odds ratio 3·26, 95% CI 1·08-9·78; p=0·026), and infection by PCR-ribotypes 018 (6·19, 1·28-29·81; p=0·023) and 056 (13·01; 1·14-148·26; p=0·039) were significantly associated with complicated disease outcome.
INTERPRETATION: PCR ribotypes other than 027 are prevalent in European hospitals. The data emphasise the importance of multicountry surveillance to detect and control C difficile infection in Europe.|
|Description: ||Comment in
Lancet. 2011 Jan 1;377(9759):8-9.
Lancet. 2011 Apr 23;377(9775):1407.|
|Peer Reviewed: ||yes|
|Publisher version: ||http://www.sciencedirect.com/science/article/pii/S0140673610612664|
|Appears in Collections:||DDI - Artigos em revistas internacionais|
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