Tracking Clostridioides difficile in Germany: Active prospective surveillance progress and molecular epidemiological trends
International Journal of Medical Microbiology, vol. 323, pp. 151742
Abstract
BACKGROUND: Clostridioides difficile infections pose significant healthcare challenges in Germany, driven by various ribotypes (RTs) and antimicrobial resistance. This study updates the molecular epidemiology through Germany's active and passive surveillance until the end of 2023, including changes during the COVID-19 pandemic. METHODS: As active surveillance, the first 10 stool samples tested positive for toxigenic C. difficile (one per patient) were collected biannually from 33 German microbiological laboratories. Passive surveillance included samples from severe cases and outbreaks. Isolates underwent genotypic characterization and antimicrobial susceptibility testing. RESULTS: Regarding active surveillance, 1257 toxigenic C. difficile isolates were retrieved between October 2021 to October 2023. Previous surveillance data (n = 876) were added dating back to 2019. Among the 2133 strains, RT014 (18%), RT078 (7%) and RT001 (6%) were the most common RTs, while RT027 declined between 2019 and 2023 from 5% to 0.6%. Concerning the passive surveillance, from 509 isolates, RT027 was most prevalent (16%), followed by RT014 (13%), RT001 and RT002 (6% each). Emerging RTs, namely RT181 and RT955, were rarely detected or absent, respectively. No resistance to vancomycin or fidaxomicin was detected, and metronidazole resistance was low (0.5%). C. difficile RT027 isolates displayed high resistance for moxifloxacin, clarithromycin and rifampicin (~95%, ~95% and~70%, respectively). During the COVID-19 pandemic, no significant trends in RT diversity were observed while the reported number of cases decreased. CONCLUSION: RT014 continues to be the most prevalent RT. Hypervirulent RTs remained rather constant, although numbers of RT027 declined over time. Ongoing surveillance remains crucial for monitoring emergent RTs.
Authors 49
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Ahmed Mohamed Mostafa Abdrabou corresponding
Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany; Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) study group for Clostridioides difficile (ESGCD), Basel, Switzerland. Electronic address: Ahmed.Abdrabou@uks.eu
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Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute of Hygiene, University Hospital of Münster, Münster, Germany
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Affiliation as printed
Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
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Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
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Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute of Laboratory Medicine, Microbiology and Hygiene, Christophorus Kliniken, Coesfeld, Germany
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Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute of Hygiene, University Hospital of Münster, Münster, Germany
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Affiliation as printed
German National Reference Center for Clostridioides (Clostridium) difficile, Homburg/Saar-Münster-Coesfeld, Germany; Institute for Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
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University of Augsburg · University Hospital Augsburg
Affiliation as printed
Institut für Labormedizin und Mikrobiologie, Universitätsklinikum Augsburg, Augsburg, Germany
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University of Augsburg · University Hospital Augsburg
Affiliation as printed
Institut für Labormedizin und Mikrobiologie, Universitätsklinikum Augsburg, Augsburg, Germany
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University of Bonn · University Hospital Bonn
Affiliation as printed
Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
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Affiliation as printed
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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Affiliation as printed
Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
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Affiliation as printed
Institute of Medical Microbiology and Hygiene, Ulm University Hospital, Ulm, 89081, Germany
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Affiliation as printed
Institute of Medical Microbiology and Hygiene, Ulm University Hospital, Ulm, 89081, Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, 37075, Germany
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Universitätsmedizin Göttingen · University of Göttingen
Affiliation as printed
Institute for Medical Microbiology, University Medical Center Göttingen, Göttingen, 37075, Germany
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Friedrich-Loeffler-Institut · Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Fleischmannstr. 10, Greifswald, D-17475, Germany
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Friedrich-Loeffler-Institut · Universitätsmedizin Greifswald · Universität Greifswald
Affiliation as printed
Friedrich Loeffler-Institute of Medical Microbiology, University Medicine Greifswald, Fleischmannstr. 10, Greifswald, D-17475, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsmedizin Frankfurt, Frankfurt am Main, D-60596, Germany
Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Goethe University Frankfurt · University Hospital Frankfurt
Affiliation as printed
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsmedizin Frankfurt, Frankfurt am Main, D-60596, Germany
Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Affiliation as printed
Universitätsklinikum Essen, Germany
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Affiliation as printed
Universitätsklinikum Essen, Germany
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Affiliation as printed
Institut für Labormedizin und Mikrobiologie & Impfzentrum, Klinikum Würzburg Mitte gGmbH, Juliuspromenade 19, Würzburg, 97070, Germany
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Klinikum Würzburg Mitte · Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Institut für Labormedizin und Mikrobiologie & Impfzentrum, Klinikum Würzburg Mitte gGmbH, Juliuspromenade 19, Würzburg, 97070, Germany; Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty of the Otto Von Guericke University, Magdeburg, Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty of the Otto Von Guericke University, Magdeburg, Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Institute of Medical Microbiology and Hospital Hygiene, Medical Faculty of the Otto Von Guericke University, Magdeburg, Germany
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Affiliation as printed
Institute for Hygiene and Microbiology, University of Würzburg, Germany
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Affiliation as printed
Institute for Hygiene and Microbiology, University of Würzburg, Germany
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Heidelberg University · University Hospital Heidelberg · University Medical Centre Mannheim
Affiliation as printed
Universitätsmedizin Mannheim Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
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Heidelberg University · University Hospital Heidelberg · University Medical Centre Mannheim
Affiliation as printed
Universitätsmedizin Mannheim Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany
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Affiliation as printed
Universitätsinstitut für medizinische Mikrobiologie u Virologie, Diagnostikzentrum, Klinikum Oldenburg, Brandenburger Str 19, Oldenburg, 26133, Germany
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Affiliation as printed
Universitätsinstitut für medizinische Mikrobiologie u Virologie, Diagnostikzentrum, Klinikum Oldenburg, Brandenburger Str 19, Oldenburg, 26133, Germany
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Universitätsklinikum Gießen und Marburg
Affiliation as printed
Universitätsklinikum Gießen und Marburg (UKGM), Marburg, Germany
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Institute of Medical Microbiology and Hygiene · Ludwig-Maximilians-Universität München
Affiliation as printed
Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Medical Faculty, LMU Munich, Pettenkoferstr. 9a, Munich, 80336, Germany
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Institute of Medical Microbiology and Hygiene · Ludwig-Maximilians-Universität München
Affiliation as printed
Max von Pettenkofer Institute for Hygiene and Medical Microbiology, Medical Faculty, LMU Munich, Pettenkoferstr. 9a, Munich, 80336, Germany
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University Hospital Schleswig-Holstein · University of Lübeck
Affiliation as printed
Institut für Med. Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany
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University Hospital Schleswig-Holstein · University of Lübeck
Affiliation as printed
Institut für Med. Mikrobiologie, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Lübeck, 23538, Germany
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University Medical Center Freiburg
Affiliation as printed
Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Hermann-Herder-Str. 11, Freiburg, 79104, Germany
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University Medical Center Freiburg
Affiliation as printed
Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Hermann-Herder-Str. 11, Freiburg, 79104, Germany
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Justus-Liebig-Universität Gießen
Affiliation as printed
Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany; German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Justus Liebig University, Giessen, Germany
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Justus-Liebig-Universität Gießen
Affiliation as printed
Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany; German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Justus Liebig University, Giessen, Germany
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Charité - Universitätsmedizin Berlin
Affiliation as printed
Labor Berlin Charité Vivantes GmbH, Berlin, Germany
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Affiliation as printed
Labordiagnostisches Zentrum (LDZ), University Hospital RWTH Aachen, Aachen, 52057, Germany
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Affiliation as printed
Institute for Medical Microbiology and Virology, University of Leipzig Medical Center, Leipzig, 04103, Germany
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Affiliation as printed
Institute for Medical Microbiology and Virology, University of Leipzig Medical Center, Leipzig, 04103, Germany
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Affiliation as printed
Institute for Medical Microbiology and Virology, University of Leipzig Medical Center, Leipzig, 04103, Germany
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Affiliation as printed
Institut für Medizinische Mikrobiologie und Hygiene, Uniklinik Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
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Affiliation as printed
Institut für Medizinische Mikrobiologie und Hygiene, Uniklinik Tübingen, Elfriede-Aulhorn-Str. 6, Tübingen, 72076, Germany
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Center for Systems Biology Dresden · Hochschule für Technik und Wirtschaft Dresden – University of Applied Sciences · Technische Universität Dresden
Affiliation as printed
Dresden, 01307, Germany
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