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Euclid study reveals more than 39,000 cases of clostridium difficile infection may be missed each year

The full set of data from EUCLID, the largest ever prevalence study of (CDI) across Europe, were presented at the 24th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). Data from 482 European hospitals reveal that in a single day, an average of 109 cases of CDI are missed due to a lack of clinical suspicion or inadequate laboratory testing, potentially leading to more than 39,000 missed cases in Europe each year.2

The study results show that incidence of CDI in Europe has increased (compared with previous studies) from 4.12 3 to 7.92 cases per 10,000 patient bed days between 2008 and 2012-13, respectively. Furthermore, the new data highlight that CDI PCR-ribotype 027, one of the most virulent PCR-ribotypes associated with CDI epidemics,4 is the most common in Europe.5 Countries with the highest rates of CDI testing had the lowest rates of this epidemic C. difficile strain.5

“Countries with increased awareness of CDI have probably been able to reduce outbreaks associated with the most virulent C. difficile strains by improving the early diagnosis of this usually healthcare associated infection” said Professor Mark Wilcox, Professor of Medical Microbiology, Leeds Teaching Hospitals & University of Leeds. “This study highlights that it is essential that we improve the implementation of CDI testing in hospitals, in order to tackle the issue of the increasing incidence of CDI across Europe.”

The EUropean multi-centre, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalised patients with Diarrhoea (EUCLID) involved 482 hospitals from 20 European countries.

These full results compare data captured on two separate days, one in winter 2012/13 and one in summer 2013. On each of the assigned days, participating hospitals submitted all received unformed faecal samples to the respective EUCLID National Coordinating laboratories (NCLs). In total, 7,181 faecal samples were submitted by participating hospitals.2

Results of this study highlight marked recent shifts in CDI testing policy and methodology across Europe, resulting in improved testing policies and selection of laboratory methods.2 The data show that false-positive rates decreased between the two study days in those countries where testing procedures and methods had improved.2 Despite this, more than 50% of hospitals are still not using the most accurate testing procedure for CDI and more than one in five (21.8%) samples found to be positive for CDI at the NCL had not been tested at the local hospital level.2 In addition, the findings reveal that over half (52.1%) of hospitals in Europe only test for CDI at a physician’s request.2

“Guidelines recommend that hospitals test for CDI on all unformed stools when the cause of diarrhoea is not clear. However we are still seeing an issue with both a lack of clinical suspicion and lack of testing for CDI”, commented Professor Mark Wilcox. “CDI is a condition which causes considerable suffering for patients and a huge economic burden to hospitals across Europe. These results reveal that there is still more to be done in order to optimise CDI management and prevention.”

The EUCLID study is being coordinated out of the University of Leeds, UK, by Professor Mark Wilcox’s research group, with support from the EUCLID Core Group. The study was initiated and financially supported by Astellas Pharma Europe Ltd.

About Clostridium difficile Infection

CDI is a serious illness resulting from infection of the internal lining of the colon by C. difficile bacteria. The bacteria produce toxins that cause inflammation of the colon, diarrhoea and, in some cases, death.6 Patients typically develop CDI after the use of broad-spectrum antibiotics that disrupt normal bowel flora, allowing C. difficile bacteria to flourish.7 CDI is the leading cause of hospital acquired (nosocomial) diarrhoea in industrialised countries8 and the risk of CDI and disease recurrence is particularly high in patients aged 65 years and older.9 Recurrence of CDI occurs in up to 25% of patients within 30 days of initial treatment with current therapies.10,11,12 The ESCMID has identified recurrence as being the most important problem in the treatment of CDI.13

Source

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2Davies KA, et al. Second report from the EUropean, multi-centre, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalised patients with Diarrhoea (EUCLID) PO753. Presented at ECCMID 2014.

3Bauer MP et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011; 377:63-73.

4Kuijper EJ, Coignard B, Tull P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 2006;12 Suppl 6:2–18.

5Davies KA. Increased diversity of C. difficile PCR-ribotypes across European countries and disparity of 027 prevalence; results of a European prevalence study of Clostridium difficile infection (EUCLID) Presented at ECCMID 2014.

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11 Lowy I, et al. Treatment with Monoclonal Antibodies against Clostridium difficile Toxins. N Engl J Med 2010;362;3:197-205.

12 Louie TJ, et al. Fidaxomicin versus vancomycin for Clostridium difficile infection. N Engl J Med 2011;364:422–31.

13 Bauer MP, et al. European Society of Clinical Microbiology and Infectious Disease (ESCMID): treatment guidance document for Clostridium difficile-infection (CDI). Clin Micro Infect 2009;15: 1067-79.

Astellas Pharma Europe Ltd