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Abstract

infection (CDI) is the major cause of infective diarrhoea in healthcare environments. As part of the European, multicentre, prospective, biannual, point-prevalence study of infection in hospitalised patients with diarrhoea (EUCLID), the largest epidemiological study of its type, PCR ribotype distribution of isolates in Europe was investigated. PCR ribotyping was performed on 1,196 isolates from diarrhoeal samples sent to the European coordinating laboratory in 2012–13 and 2013 (from two sampling days) by 482 participating hospitals from 19 European countries. A total of 125 ribotypes were identified, of which ribotypes 027 (19%, n =222), 001/072 (11%, n = 134) and 014/020 (10%, n = 119) were the most prevalent. Distinct regional patterns of ribotype distribution were noted. Of 596 isolates from patients with toxin-positive stools (CDI cases), ribotype 027 accounted for 22% (32/144) of infections in cases aged from 18 to less than 65 years, but the prevalence decreased in those aged ≥ 65 years (14% (59/412)) and further decreased in those aged ≥ 81 years (9% (18/195)). The prevalence of ribotype 027 and 176, but not other epidemic strains, was inversely proportional to overall ribotype diversity (R2 = 0.717). This study highlights an increased diversity of ribotypes across Europe compared with previous studies, with considerable intercountry variation in ribotype distribution. Continuous surveillance programmes are necessary to monitor the changing epidemiology of .

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/content/10.2807/1560-7917.ES.2016.21.29.30294
2016-07-21
2017-11-24
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.29.30294
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References

  1. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals 2011–2012. Stockholm: ECDC; 2013. Available from: http://ecdc.europa.eu/en/publications/_layouts/forms/Publication_DispForm.aspx?List=4f55ad51-4aed-4d32-b960-af70113dbb90&ID=865?
  2. Schmid D, Kuo HW, Simons E, Kanitz EE, Wenisch J, Allerberger F, et al. All-cause mortality in hospitalized patients with infectious diarrhea: Clostridium difficile versus other enteric pathogens in Austria from 2008 to 2010. J Infect Public Health. 2014;7(2):133-44.  https://doi.org/10.1016/j.jiph.2013.07.010  PMID: 24231157 
  3. Wenisch JM, Schmid D, Tucek G, Kuo HW, Allerberger F, Michl V, et al. A prospective cohort study on hospital mortality due to Clostridium difficile infection. Infection. 2012;40(5):479-84.  https://doi.org/10.1007/s15010-012-0258-1  PMID: 22527876 
  4. Hensgens MPM, Goorhuis A, Dekkers OM, van Benthem BHB, Kuijper EJ. All-cause and disease-specific mortality in hospitalized patients with Clostridium difficile infection: a multicenter cohort study. Clin Infect Dis. 2013;56(8):1108-16.  https://doi.org/10.1093/cid/cis1209  PMID: 23300235 
  5. Planche TD, Davies KA, Coen PG, Finney JM, Monahan IM, Morris KA, et al. Differences in outcome according to Clostridium difficile testing method: a prospective multicentre diagnostic validation study of C difficile infection. Lancet Infect Dis. 2013;13(11):936-45.  https://doi.org/10.1016/S1473-3099(13)70200-7  PMID: 24007915 
  6. Valiente E, Dawson LF, Cairns MD, Stabler RA, Wren BW. Emergence of new PCR ribotypes from the hypervirulent Clostridium difficile 027 lineage. J Med Microbiol. 2012;61(Pt 1):49-56.  https://doi.org/10.1099/jmm.0.036194-0  PMID: 21903827 
  7. He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013;45(1):109-13.  https://doi.org/10.1038/ng.2478  PMID: 23222960 
  8. Rupnik M, Wilcox MH, Gerding DN. Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol. 2009;7(7):526-36.  https://doi.org/10.1038/nrmicro2164  PMID: 19528959 
  9. Valiente E, Cairns MD, Wren BW. The Clostridium difficile PCR ribotype 027 lineage: a pathogen on the move. Clin Microbiol Infect. 2014;20(5):396-404.  https://doi.org/10.1111/1469-0691.12619  PMID: 24621128 
  10. Goorhuis A, Van der Kooi T, Vaessen N, Dekker FW, Van den Berg R, Harmanus C, et al. Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in The Netherlands. Clin Infect Dis. 2007;45(6):695-703.  https://doi.org/10.1086/520984  PMID: 17712752 
  11. Bauer MP, Notermans DW, van Benthem BHB, Brazier JS, Wilcox MH, Rupnik M, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011;377(9759):63-73.  https://doi.org/10.1016/S0140-6736(10)61266-4  PMID: 21084111 
  12. Davies KA, Longshaw CM, Davis GL, Bouza E, Barbut F, Barna Z, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208-19.  https://doi.org/10.1016/S1473-3099(14)70991-0  PMID: 25455988 
  13. Alcalá L, Martín A, Marín M, Sánchez-Somolinos M, Catalán P, Peláez T, et al. The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? Clin Microbiol Infect. 2012;18(7):E204-13.  https://doi.org/10.1111/j.1469-0691.2012.03883.x  PMID: 22563775 
  14. Enoch DA, Butler MJ, Pai S, Aliyu SH, Karas JA. Clostridium difficile in children: colonisation and disease. J Infect. 2011;63(2):105-13.  https://doi.org/10.1016/j.jinf.2011.05.016  PMID: 21664931 
  15. Faust SN, Wilcox MH, Banaszkiewicz A, Bouza E, Raymond J, Gerding DN. Lack of evidence for an unmet need to treat Clostridium difficile infection in infants aged <2 years: expert recommendations on how to address this issue. Clin Infect Dis. 2015;60(6):912-8.  https://doi.org/10.1093/cid/ciu936  PMID: 25422389 
  16. de Graaf H, Pai S, Burns DA, Karas JA, Enoch DA, Faust SN. Co-infection as a confounder for the role of Clostridium difficile infection in children with diarrhoea: a summary of the literature. Eur J Clin Microbiol Infect Dis. 2015;34(7):1281-7.  https://doi.org/10.1007/s10096-015-2367-0  PMID: 25926302 
  17. Fawley WN, Knetsch CW, MacCannell DR, Harmanus C, Du T, Mulvey MR, et al. Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridium difficile. PLoS One. 2015;10(2):e0118150.  https://doi.org/10.1371/journal.pone.0118150  PMID: 25679978 
  18. United Nations Statistics Division. Composition of macro geographical (continental) regions, geographical sub-regions, and selected economic and other groupings. Revised 31 Oct 2013. New York: United Nations. [Accessed 30 Jan 2015]. Available from: http://unstats.un.org/unsd/methods/m49/m49regin.htm
  19. Nyč O, Pituch H, Matějková J, Obuch-Woszczatynski P, Kuijper EJ. Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland. Lancet. 2011;377(9775):1407.  https://doi.org/10.1016/S0140-6736(11)60575-8  PMID: 21515161 
  20. Krutova M, Matejkova J, Nyc O. C. difficile ribotype 027 or 176? Folia Microbiol (Praha). 2014;59(6):523-6.  https://doi.org/10.1007/s12223-014-0323-5  PMID: 24970104 
  21. Ashwin H, Davies KA, Davis GL, Lee F, Longshaw CM, Wilcox MH. Optimised diagnosis of Clostridium difficile infection; is there still room for improvement? Results of a European point prevalence study of C. difficile infection (EUCLID). Poster presented at 24th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), 10-13 May 2014, Barcelona, Spain. P0738.
  22. Eastwood K, Else P, Charlett A, Wilcox M. Comparison of nine commercially available Clostridium difficile toxin detection assays, a real-time PCR assay for C. difficile tcdB, and a glutamate dehydrogenase detection assay to cytotoxin testing and cytotoxigenic culture methods. J Clin Microbiol. 2009;47(10):3211-7.  https://doi.org/10.1128/JCM.01082-09  PMID: 19710274 
  23. Brazier JS, Patel B, Pearson A. Distribution of Clostridium difficile PCR ribotype 027 in British hospitals. Euro Surveill. 2007;12(4):E070426.2. PMID: 17868609 
  24. Brazier JS, Raybould R, Patel B, Duckworth G, Pearson A, Charlett A, et al. Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007-08. Euro Surveill. 2008;13(41):19000. PMID: 18926105 
  25. Wilcox MH, Shetty N, Fawley WN, Shemko M, Coen P, Birtles A, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis. 2012;55(8):1056-63.  https://doi.org/10.1093/cid/cis614  PMID: 22784871 
  26. Public Health England (PHE). Clostridium difficile Ribotyping Network (CDRN) for England and Northern Ireland. 2011-13 report. London: PHE; 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/329156/C_difficile_ribotyping_network_CDRN_report.pdf
  27. Ashiru-Oredope D, Sharland M, Charani E, McNulty C, Cooke JARHAI Antimicrobial Stewardship Group. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart--Then Focus. J Antimicrob Chemother. 2012;67(Suppl 1):i51-63.  https://doi.org/10.1093/jac/dks202  PMID: 22855879 
  28. Miller M, Gravel D, Mulvey M, Taylor G, Boyd D, Simor A, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010;50(2):194-201.  https://doi.org/10.1086/649213  PMID: 20025526 
  29. Ludlam H, Brown N, Sule O, Redpath C, Coni N, Owen G. An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea. Age Ageing. 1999;28(6):578-80.  https://doi.org/10.1093/ageing/28.6.578  PMID: 10604512 
  30. Wilcox MH, Freeman J, Fawley W, MacKinlay S, Brown A, Donaldson K, et al. Long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of Clostridium difficile diarrhoea. J Antimicrob Chemother. 2004;54(1):168-72.  https://doi.org/10.1093/jac/dkh285  PMID: 15163654 
  31. Eyre DW, Walker AS, Griffiths D, Wilcox MH, Wyllie DH, Dingle KE, et al. Clostridium difficile mixed infection and reinfection. J Clin Microbiol. 2012;50(1):142-4.  https://doi.org/10.1128/JCM.05177-11  PMID: 22075589 
  32. Tanner HE, Hardy KJ, Hawkey PM. Coexistence of multiple multilocus variable-number tandem-repeat analysis subtypes of Clostridium difficile PCR ribotype 027 strains within fecal specimens. J Clin Microbiol. 2010;48(3):985-7.  https://doi.org/10.1128/JCM.02012-09  PMID: 20071546 
  33. Wroblewski D, Hannett GE, Bopp DJ, Dumyati GK, Halse TA, Dumas NB, et al. Rapid molecular characterization of Clostridium difficile and assessment of populations of C. difficile in stool specimens. J Clin Microbiol. 2009;47(7):2142-8.  https://doi.org/10.1128/JCM.02498-08  PMID: 19403775 
  34. Broukhanski G, Simor A, Pillai DR. Defining criteria to interpret multilocus variable-number tandem repeat analysis to aid Clostridium difficile outbreak investigation. J Med Microbiol. 2011;60(Pt 8):1095-100.  https://doi.org/10.1099/jmm.0.029819-0  PMID: 21474615 
  35. van den Berg RJ, Ameen HA, Furusawa T, Claas EC, van der Vorm ER, Kuijper EJ. Coexistence of multiple PCR-ribotype strains of Clostridium difficile in faecal samples limits epidemiological studies. J Med Microbiol. 2005;54(Pt 2):173-9.  https://doi.org/10.1099/jmm.0.45825-0  PMID: 15673513 
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