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Lancet. 2011 Jan 1;377(9759):63-73. doi: 10.1016/S0140-6736(10)61266-4.

Clostridium difficile infection in Europe: a hospital-based survey.

Collaborators (143)

Allerberger F, Hartman G, Hell M, Wechsler-Fördös A, Delmee M, Gordts B, Laffineur K, Ivanova K, Marina M, Dzhigosheva E, Filefski G, Matica B, Golubic D, Punda-Polic V, Andrasevic AT, Maikanti-Charalampous P, Bagazouni D, Nyč O, Mejzlíkova L, Geigerova L, Olsen KE, Brock I, Holt H, Thomsen MK, Jyrna-Ellam M, Virolainen-Julkunen A, Mikkola J, Mattila E, Broas M, Petrovska M, Barbut F, Descamps D, Canone JP, Lalande V, Lemée L, Cavalie L, Kleinkauf N, Kola A, Knüfermann R, Kist M, Fenner I, Rodloff A, von Eichel-Streiber C, Borgmann S, Michael R, Malamou-Lada E, Orfanidou M, Avlami A, Kanellopoulou M, Nagy E, Konkoly-Thege M, Terhes G, Lenke S, Hardarson H, Hardardottir H, Fitzpatrick F, Skally M, Smyth E, Fenelon L, Schaffer K, Cormican M, Mastrantonio P, Raglio A, Nicoletti P, Dettori G, Mazzella P, Zaccaria T, Balode AO, Aksenoka K, Zvingelis G, Liepins M, Lee C, Mossong J, Even J, Hakim A, Caruana P, Kuijper EJ, Debast SB, Bloembergen P, Harmanus C, Sanders I, Ingrebretsen A, Iversen BG, Jenum PA, Afset JE, Pituch H, Pawlowska J, Pituch H, Pituch H, Furtado C, Guiomar Moreira R, Machado J, Sancho L, Ribeiro G, Ramos H, Lemeni D, Serban R, Ciocîrlan M, Rafila A, Lesanu G, Danaila E, Szekely E, Melková R, Novakova E, Glosova L, Novakova E, Rupnik M, Zupanc TL, Kevorkijan BK, Lesnicar G, Bouza E, Hernández LA, Abarca J, Ribas AM, Sala IS, García MI, Åkerlund T, Wullt M, Norén T, Weintraub A, Nord C, Widmer AF, Widmer A, Widmer A, Levent B, Kacar S, Hascelik G, Sener B, Azap O, Arslan H, Sinirtas M, Akalin H, Ulger N, Soyletir G, Petrovska M, Wilcox M, Patel B, Rooney P, Wiuff C, Gibb A, Coia J, Torné AN, Tüll P.

Author information

Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, Netherlands.



Little is known about the extent of Clostridium difficile infection in Europe. Our aim was to obtain a more complete overview of C difficile infection in Europe and build capacity for diagnosis and surveillance.


We set up a network of 106 laboratories in 34 European countries. In November, 2008, one to six hospitals per country, relative to population size, tested stool samples of patients with suspected C difficile infection or diarrhoea that developed 3 or more days after hospital admission. A case was defined when, subsequently, toxins were identified in stool samples. Detailed clinical data and stool isolates were collected for the first ten cases per hospital. After 3 months, clinical data were followed up.


The incidence of C difficile infection varied across hospitals (weighted mean 4·1 per 10,000 patient-days per hospital, range 0·0-36·3). Detailed information was obtained for 509 patients. For 389 of these patients, isolates were available for characterisation. 65 different PCR ribotypes were identified, of which 014/020 (61 patients [16%]), 001 (37 [9%]), and 078 (31 [8%]) were the most prevalent. The prevalence of PCR-ribotype 027 was 5%. Most patients had a previously identified risk profile of old age, comorbidity, and recent antibiotic use. At follow up, 101 (22%) of 455 patients had died, and C difficile infection played a part in 40 (40%) of deaths. After adjustment for potential confounders, an age of 65 years or older (adjusted odds ratio 3·26, 95% CI 1·08-9·78; p=0·026), and infection by PCR-ribotypes 018 (6·19, 1·28-29·81; p=0·023) and 056 (13·01; 1·14-148·26; p=0·039) were significantly associated with complicated disease outcome.


PCR ribotypes other than 027 are prevalent in European hospitals. The data emphasise the importance of multicountry surveillance to detect and control C difficile infection in Europe.


European Centre for Disease Prevention and Control.

[Indexed for MEDLINE]

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