Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland

Emerging infectious diseases, vol. 26, pp. 2370–2377

Abstract

ince its identification as a cause of antibiotic-as- sociated pseudomembraneous colitis in 1978 (1), Clostridioides difficile has emerged as a major healthcare-associated pathogen worldwide.In the United States, C. difficile infection (CDI) rates doubled during 1996-2003 (2), and rates of CDI were reported to be 76.9 cases/10,000 discharges in 2005 (3).In a more recent national point-prevalence study including US healthcare facility in-patients, 13/1,000 patients were found to be either infected or colonized (4), a higher rate than had been previously estimated.In a national point-prevalence study of nosocomial infections in the United States, C. difficile was the most common causative pathogen overall (5).The increase largely has been attributed to the emergence of the hypervirulent strain, PCR ribotype 027 (RT027), which was identified as causative strain in 82% of cases during CDI outbreaks in Quebec, Canada, during 2001-2003 and accounted for 31% of all cases of healthcare-associated infections in the United States in 2011 (6-9).In Europe, CDI incidence varies across hospitals and countries with a weighted mean of 4.1 cases/10,000 patient-days per hospital in 2008 (10).The most recent study on CDI prevalence in Europe suggests an increase in the number of cases, reporting a mean of 7.0 cases/10,000 patient-bed days and ranging among countries from 0.7 to 28.7 cases/10,000 patient-bed days (11).The most common ribotype identified was RT027, which was detected in 4 countries: Germany, Hungary, Poland, and Romania (11).To estimate and compare the burden of CDI across the United States, the US Centers for Disease Control and Prevention (CDC) began populationbased CDI surveillance in 10 locations in 2011 (12).The European Centre for Disease Prevention and Control (ECDC) began coordinating CDI surveillance in acute care hospitals in Europe in 2016 (13).Both authorities provide case definitions based on different diagnostic approaches, including detection of C. difficile toxin A and B by enzyme immunoassay (EIA) or detection of toxin-producing C. difficile organisms by PCR.However, the use of different diagnostic algorithms to detect C. difficile might hamper comparisons between institutions and countries.Therefore, in a nationwide C. difficile multicenter prevalence study in Switzerland, we systematically compared surveillance measures based on detection of C. difficile in stool by either PCR as a stand-alone Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficileSurveillance, Switzerland

Authors 9

1. Andreas Franz Widmer Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

2. Reno Frei Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

3. Ed J. Kuijper Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   University Hospital Basel , Basel , Switzerland

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

4. Mark H. Wilcox Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   University Hospital Basel , Basel , Switzerland

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

5. Ruth Schindler Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

6. Violeta Spaniol Aachen

   University of Leeds · Leeds Teaching Hospitals NHS Trust · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leeds Institute of Biomedical and Clinical Sciences , University of Leeds , and Leeds Teaching Hospitals , Leeds , UK

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

7. Daniel Goldenberger Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

8. Adrian Egli Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland

9. Sarah Tschudin‐Sutter corresponding Aachen

   University of Leeds · Leiden University Medical Center · University Hospital of Basel

   Affiliation as printed

   Leiden University Medical Center , Leiden , the Netherlands

   Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, and Leeds Teaching Hospitals, Leeds, UK

   Sutter); Leiden University Medical Center, Leiden, the Netherlands

   University Hospital Basel, Basel, Switzerland