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

Abstract

S ince its identification as a cause of antibiotic-associated 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.

Epidemiology, outcomes and risk factors for recurrence of Clostridioides difficile infections following allogeneic hematopoietic cell transplantation: a longitudinal retrospective multicenter study

“…We found an overall CDI incidence of 8.5% which is in line with the data reported in a previous metaanalysis [ 1 ]. Similarly to this study, we observed an increasing trend over time, which could be partially attributed to the enhanced sensitivity of molecular diagnostics now widely employed in most centers [ 3 ]. In our cohort, with an extensive surveillance after HCT, the majority of CDI cases (64.9%) were diagnosed during the post-engraftment period.…”

“…Our findings showed that over 80% of patients had mild disease, consistent with previous studies in onco-hematological patients [ 7 ]. The lower prevalence of hypervirulent ribotypes in Switzerland, such as ribotype 027 [ 3 ], could contribute to this finding. Around 18% of patients in our cohort experienced CDI recurrence.…”

Treatment and Outcomes of Clostridioides difficile Infection in Switzerland: A Two-Center Retrospective Cohort Study

“…Diagnostic approaches have considerably evolved over the years [6,7]; the introduction and wide use of nucleic acid amplification tests (NAAT) offers great advantages, including high sensitivity and short turnaround times, but has raised concerns about the overdiagnosis of CDI [3][4][5]. In a nationwide multicenter pointprevalence study in Switzerland, the mean prevalence rate was 9.3 cases/10,000 patient bed-days when using a PCR detection method, and lower when using a two-stage enzyme immunoassay (EIA)-based algorithm (6.1 cases/10,000 patient bed-days) [8]. Despite the advancements in diagnostic methods, the optimal diagnostic algorithm remains debated, and strategies vary considerably between centers.…”

“…Despite the advancements in diagnostic methods, the optimal diagnostic algorithm remains debated, and strategies vary considerably between centers. A better appreciation of local diagnostic approaches is vital for evaluating CDI burden [8,9].…”

Molecular Methods for Pathogenic Bacteria Detection and Recent Advances in Wastewater Analysis

“…The cross-reactivity with other bacteria happened due to the presence of a constituent sugar of LPS. One recent method comparison study for C. difficile surveillance in Switzerland showed that, compared to the PCR method, enzyme immunoassay led to more falsenegative results of human stool samples [148]. Immunological methods usually require preenrichment to expose surface antigens, which leads to extended detection time.…”