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Abstract

Background

There is a paucity of data on community-based infection (CDI) and how these compare with inpatient CDI.

Aim

To compare data on the populations with CDI in hospitals vs the community across 12 European countries.

Methods

For 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 with or without free toxin.

Results

The 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).

Conclusion

These findings support recommendations for improving diagnosis in patients presenting with diarrhoea in the community, to guide good practice to limit the spread of CDI.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2022-06-30
2024-04-20
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.26.2100704
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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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Virginie+F+Viprey&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Viprey Virginie F</a>, <a href="/search?value1=Georgina+L+Davis&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davis Georgina L</a>, <a href="/search?value1=Anthony+D+Benson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benson Anthony D</a>, <a href="/search?value1=Duncan+Ewin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ewin Duncan</a>, <a href="/search?value1=William+Spittal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Spittal William</a>, <a href="/search?value1=Jon+J+Vernon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vernon Jon J</a>, <a href="/search?value1=Maja+Rupnik&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rupnik Maja</a>, <a href="/search?value1=Alice+Banz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Banz Alice</a>, <a href="/search?value1=Florence+Allantaz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Allantaz Florence</a>, <a href="/search?value1=Philippe+Cleuziat&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cleuziat Philippe</a>, <a href="/search?value1=the+COMBACTE-CDI+National+Coordinators&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the COMBACTE-CDI National Coordinators</a>, <a href="/search?value1=Mark+H+Wilcox&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wilcox Mark H</a>, <a href="/search?value1=Kerrie+A+Davies&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davies Kerrie A</a>, <a href="/search?value1=on+behalf+of+the+COMBACTE-CDI+consortium&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the COMBACTE-CDI consortium</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2022;27(26):pii=2100704. <a href="https://doi.org/10.2807/1560-7917.ES.2022.27.26.2100704" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2022.27.26.2100704</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 07 Jul 2021;&nbsp;&nbsp; <span class="generated">Accepted</span>: 05 Apr 2022 </span> </p>
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