Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID).

Autor:	Davies KA; EUCLID European Coordinators, University of Leeds, Leeds, UK., Longshaw CM; Astellas Pharma Europe, Chertsey, UK., Davis GL; EUCLID European Coordinators, University of Leeds, Leeds, UK., Bouza E; Catedrático-Jefe de Servicio, Microbiologica Clinica E Infecciosas, Hospital General Universitario 'Gregorio Marañón', Madrid, Spain., Barbut F; National Reference Laboratory for Clostridium difficile, Université Pierre et Marie Curie, Paris, France., Barna Z; Department of Bacteriology, National Centre for Epidemiology, Budapest, Hungary., Delmée M; Univerisité Catholique de Louvain, Institut de Recherché Expérimentale et Clinique (IREC), Brussels, Belgium., Fitzpatrick F; Health Protection Surveillance Centre and Beaumont Hospital, Dublin, Ireland., Ivanova K; National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria., Kuijper E; Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands., Macovei IS; 'Cantacuzino' National Institute of Research and Development for Microbiology and Immunology, Bucharest, Romania., Mentula S; Bacteriology Unit, National Institute for Health and Welfare (THL), Helsinki, Finland., Mastrantonio P; Istituto Superiore di Sanità, Department of Infectious Diseases, Rome, Italy., von Müller L; Institute of Medical Microbiology and Hygiene, University of Saarland Medical Centre, Homburg/Saar, Germany., Oleastro M; Department of Infectious Diseases, National Institute for Health 'Dr Ricardo Jorge', Lisbon, Portugal., Petinaki E; University Hospital, Medical School, University of Thessalia, Larissa, Greece., Pituch H; Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland., Norén T; Örebro University Hospital, Örebro, Sweden., Nováková E; Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Martin, Slovakia., Nyč O; Department of Medical Microbiology, University Hospital in Motol, Prague, Czech Republic., Rupnik M; National Laboratory for Health, Environment and Food (NLZOH), and University of Maribor, Faculty of Medicine, Maribor, Slovenia., Schmid D; Austrian Agency for Health and Food Safety, Institute for Medical Microbiology and Hygiene, Vienna, Austria., Wilcox MH; EUCLID European Coordinators, University of Leeds, Leeds, UK. Electronic address: mark.wilcox@leedsth.nhs.uk.
Jazyk:	angličtina
Zdroj:	The Lancet. Infectious diseases [Lancet Infect Dis] 2014 Dec; Vol. 14 (12), pp. 1208-19. Date of Electronic Publication: 2014 Nov 07.
DOI:	10.1016/S1473-3099(14)70991-0
Abstrakt:	Background: Variations in testing for Clostridium difficile infection can hinder patients' care, increase the risk of transmission, and skew epidemiological data. We aimed to measure the underdiagnosis of C difficile infection across Europe. Methods: We did a questionnaire-based study at 482 participating hospitals across 20 European countries. Hospitals were questioned about their methods and testing policy for C difficile infection during the periods September, 2011, to August, 2012, and September, 2012, to August, 2013. On one day in winter, 2012-13 (December, 2012, or January, 2013), and summer, 2013 (July or August), every hospital sent all diarrhoeal samples submitted to their microbiology laboratory to a national coordinating laboratory for standardised testing of C difficile infection. Our primary outcome measures were the rates of testing for and cases of C difficile infection per 10 000 patient bed-days. Results of local and national C difficile infection testing were compared with each other. If the result was positive at the national laboratory but negative at the local hospital, the result was classified as undiagnosed C difficile infection. We compared differences in proportions with the Mann-Whitney test, or McNemar's test if data were matched. Findings: During the study period, participating hospitals reported a mean of 65·8 tests (country range 4·6-223·3) for C difficile infection per 10 000 patient-bed days and a mean of 7·0 cases (country range 0·7-28·7) of C difficile infection per 10 000 patient-bed days. Only two-fifths of hospitals reported using optimum methods for testing of C difficile infection (defined by European guidelines), although the number of participating hospitals using optimum methods increased during the study period, from 152 (32%) of 468 in 2011-12 to 205 (48%) of 428 in 2012-13. Across all 482 European hospitals on the two sampling days, 148 (23%) of 641 samples positive for C difficile infection (as determined by the national laboratory) were not diagnosed by participating hospitals because of an absence of clinical suspicion, equating to about 74 missed diagnoses per day. Interpretation: A wide variety of testing strategies for C difficile infection are used across Europe. Absence of clinical suspicion and suboptimum laboratory diagnostic methods mean that an estimated 40 000 inpatients with C difficile infection are potentially undiagnosed every year in 482 European hospitals. Funding: Astellas Pharmaceuticals Europe. (Copyright © 2014 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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