National surveillance to the incidence of Clostridium difficile-associated diarrhoea in the Netherlands
Abstract number: p1639
Paltansing S., Guseinova R., van den Berg R., Visser C., van der Vorm E., Kuijper E.J.
The recent outbreaks of Clostridium difficile-associated diarrhoea (CDAD) due to the new emerging PCR-ribotype 027, toxinotype III strains has renewed the interest of CDAD as an important nosocomial infection. To determine the incidence of CDAD in the Netherlands, we conducted a prospective surveillance study in 13 hospitals in the Netherlands.
From May 1st to July 1st of 2005, 13 participating hospitals registered all patients diagnosed with CDAD. A standardized questionnaire was devised to obtain patient information. Faeces samples or isolated strains were sent to the Reference Laboratory at the LUMC for culture and the presence of genes for toxins A and B (TcdA and TcdB). PCR-ribotyping was performed according to the method of Bidet and toxinotyping as described by Rupnik et al.
Routine methods to diagnose CDAD in 13 laboratories included combinations of cytotoxicity tests (59%), enzyme-immunoassays (56%) and culture of toxinogenic strains (31%). In total, 91 patients with CDAD were reported. The overall incidence (median) of CDAD was 17 for 10,000 patient admissions and varied from 1 to 75. Of 91 patients with CDAD, 41% was community acquired. The median age of 54 patients with nosocomial acquired CDAD was 59 years. Of 54 patients with CDAD, 7 (13.9%) died during the study period. At least 41 different PCR-ribotypes could be recognized among 91 strains. Type 027 was identified in 9 patients from 1 hospital. Toxinotyping revealed the presence of at least 7 different types. Of 91 strains, 87% were TcdA+/TcdB+, 10% TcdA-/TcdB- and 3% TcdA-/TcdB+.
The incidence of CDAD in the Netherlands is lower than reported in USA and Canada, but varied considerably per hospital. The new emerging type 027 was found in 9 patients from 1 hospital with a high incidence of CDAD (39 per 10,000 admissions).
|Session name:||XXIst ISTH Congress|
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