Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 154 No. 3 (2024)

Evaluation of a surveillance system for Clostridioides difficile infections for Swiss hospitals

DOI
https://doi.org/10.57187/s.3571
Cite this as:
Swiss Med Wkly. 2024;154:3571
Published
05.03.2024

Summary

AIMS:This study evaluated an approach to establishing a comprehensive nationwide surveillance system for Clostridioides difficile infection in Switzerland. We report the results of patient-related surveillance and calculate the incidence rate of C. difficile infection in Switzerland in 2022.

METHODS: Initiated in 2017 by the National Centre for Infection Prevention (Swissnoso), in collaboration with the Swiss Centre for Antibiotic Resistance (ANRESIS), laboratory surveillance enables the automatic import of C. difficile infection laboratory data and is fully operational. However, the very limited number of participating laboratories impedes the generation of representative results. To address this gap, Swissnoso introduced patient-related surveillance, with a questionnaire-based survey used across Swiss acute care hospitals.

RESULTS: This survey revealed an incidence of 3.8 (Poisson 95% CI: 3.2–4.5) C. difficile infection episodes per 10,000 patient-days, just above the mean rate reported by the European Centre for Disease Prevention and Control (ECDC). Additionally, we report substantial heterogeneity in laboratory tests, diagnostic criteria and infection control practices among Swiss hospitals.

CONCLUSION: This study underscores the importance of a joint effort towards standardized surveillance practices in providing comprehensive insights into C. difficile infection epidemiology and effective prevention strategies in Swiss healthcare settings. The patient-related approach remains the gold standard for C. difficile infection surveillance, although it demands substantial resources and provides results only annually. The proposed implementation of nationwide automated laboratory-based surveillance would be pragmatic and efficient, empowering authorities and hospitals to detect outbreaks promptly and to correlate infection rates with antibiotic consumption.

References

  1. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015 Feb;372(9):825–34. 10.1056/NEJMoa1408913 DOI: https://doi.org/10.1056/NEJMoa1408913
  2. Burden of Clostridium difficile Infection in the United States. N Engl J Med. 2015;372(24):2368–70. 10.1056/NEJMc1505190 DOI: https://doi.org/10.1056/NEJMc1505190
  3. Durovic A, Widmer AF, Tschudin-Sutter S. New insights into transmission of Clostridium difficile infection-narrative review. Clin Microbiol Infect. 2018 May;24(5):483–92. 10.1016/j.cmi.2018.01.027 DOI: https://doi.org/10.1016/j.cmi.2018.01.027
  4. Feuerstadt P, Theriault N, Tillotson G. The burden of CDI in the United States: a multifactorial challenge. BMC Infect Dis. 2023 Mar;23(1):132. 10.1186/s12879-023-08096-0 DOI: https://doi.org/10.1186/s12879-023-08096-0
  5. Kenneally C, Rosini JM, Skrupky LP, Doherty JA, Hollands JM, Martinez E, et al. Analysis of 30-day mortality for clostridium difficile-associated disease in the ICU setting. Chest. 2007 Aug;132(2):418–24. 10.1378/chest.07-0202 DOI: https://doi.org/10.1378/chest.07-0202
  6. Lim SC, Knight DR, Riley TV. Clostridium difficile and One Health. Clin Microbiol Infect. 2020 Jul;26(7):857–63. 10.1016/j.cmi.2019.10.023 DOI: https://doi.org/10.1016/j.cmi.2019.10.023
  7. McFarland LV, Surawicz CM, Rubin M, Fekety R, Elmer GW, Greenberg RN. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect Control Hosp Epidemiol. 1999 Jan;20(1):43–50. 10.1086/501553 DOI: https://doi.org/10.1086/501553
  8. Johnson TM, Molina KC, Howard AH, Schwarz K, Allen L, Huang M, et al. Real-World Comparison of Bezlotoxumab to Standard of Care Therapy for Prevention of Recurrent Clostridioides difficile Infection in Patients at High Risk for Recurrence. Clin Infect Dis. 2022 May;74(9):1572–8. 10.1093/cid/ciab674 DOI: https://doi.org/10.1093/cid/ciab674
  9. Dingle KE, Didelot X, Quan TP, Eyre DW, Stoesser N, Golubchik T, et al.; Modernising Medical Microbiology Informatics Group. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lancet Infect Dis. 2017 Apr;17(4):411–21. 10.1016/S1473-3099(16)30514-X DOI: https://doi.org/10.1016/S1473-3099(16)30514-X
  10. Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017 Sep;17(9):990–1001. 10.1016/S1473-3099(17)30325-0 DOI: https://doi.org/10.1016/S1473-3099(17)30325-0
  11. Marra AR, Perencevich EN, Nelson RE, Samore M, Khader K, Chiang HY, et al. Incidence and Outcomes Associated With Clostridium difficile Infections: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020 Jan;3(1):e1917597. 10.1001/jamanetworkopen.2019.17597 DOI: https://doi.org/10.1001/jamanetworkopen.2019.17597
  12. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, et al.; ECDIS Study Group. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011 Jan;377(9759):63–73. 10.1016/S0140-6736(10)61266-4 DOI: https://doi.org/10.1016/S0140-6736(10)61266-4
  13. van Dorp SM, Kinross P, Gastmeier P, Behnke M, Kola A, Delmée M, et al.; European Clostridium difficile Infection Surveillance Network (ECDIS-Net) on behalf of all participants. Standardised surveillance of Clostridium difficile infection in European acute care hospitals: a pilot study, 2013. Euro Surveill. 2016 Jul;21(29): 10.2807/1560-7917.ES.2016.21.29.30293 DOI: https://doi.org/10.2807/1560-7917.ES.2016.21.29.30293
  14. Dey A. ECDC - Annual epidemiological report for 2016-2017. Clostridioides (Clostridium) difficile infections. Annual epidemiological report for 2016–2017.
  15. Tschudin-Sutter S, Kuijper EJ, Durovic A, Vehreschild MJ, Barbut F, Eckert C, et al.; Committee. Guidance document for prevention of Clostridium difficile infection in acute healthcare settings. Clin Microbiol Infect. 2018 Oct;24(10):1051–4. 10.1016/j.cmi.2018.02.020 DOI: https://doi.org/10.1016/j.cmi.2018.02.020
  16. McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar;66(7):e1–48. 10.1093/cid/cix1085 DOI: https://doi.org/10.1093/cid/cix1085
  17. BFS. BFS - Bundesamt für Statistik Katalogdatenbanken: Federal office of Statistics Internet cited 2023 Oct 8. Available from: https://www.bfs.admin.ch/bfs/de/home/statistiken/katalogedatenbanken.assetdetail.23568235.html
  18. CDC. https://www.cdc.gov/hai/eip/cdiff-tracking.html cited 2023 Oct 8.
  19. ECDC. https://www.ecdc.europa.eu/en/clostridioides-difficile-infections Internet cited 2023 Oct 8. Available from: https://www.ecdc.europa.eu/en/clostridioides-difficile-infections
  20. SurveyMonkey. San Mateo, California, USA: SurveyMonkey Inc.
  21. Wilcox MH, Gerding DN, Poxton IR, Kelly C, Nathan R, Birch T, et al.; MODIFY I and MODIFY II Investigators. Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection. N Engl J Med. 2017 Jan;376(4):305–17. 10.1056/NEJMoa1602615
  22. Krutova M, Kinross P, Barbut F, Hajdu A, Wilcox MH, Kuijper EJ, et al.; survey contributors. How to: surveillance of Clostridium difficile infections. Clin Microbiol Infect. 2018 May;24(5):469–75. 10.1016/j.cmi.2017.12.008 DOI: https://doi.org/10.1016/j.cmi.2017.12.008
  23. Crobach MJ, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect. 2016 Aug;22 Suppl 4:S63–81. 10.1016/j.cmi.2016.03.010 DOI: https://doi.org/10.1016/j.cmi.2016.03.010
  24. Gupta A, Cifu AS, Khanna S. Diagnosis and Treatment of Clostridium difficile Infection. JAMA. 2018 Sep;320(10):1031–2. 10.1001/jama.2018.12194 DOI: https://doi.org/10.1001/jama.2018.12194

Most read articles by the same author(s)