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Clin Microbiol Infect. 2012 Jul;18(7):E204-13. doi: 10.1111/j.1469-0691.2012.03883.x. Epub 2012 May 7.

The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem?

Collaborators (229)

Palacios P, Michaus Oquiñena M, Pariente Martín M, Crespo Sánchez M, Ruiz García M, Álvarez Paredes L, Royo García G, Elía M, Sánchez-Yebra Romera W, Morales Torres M, Enríquez de Salamanca A, Iglesias Rodríguez B, Prendes Peláez P, Barreiro Hurlé L, Ordás Álvarez JF, Martínez M, Santos Rionda M, Villa Bajo L, Vázquez Valdés F, de la Iglesia Martínez P, Sánchez Folgueras I, Sánchez Arroyo R, Gómez del Campo A, Sánchez Silos R, Blanco Palenciano J, Fajardo Olivares M, Vila Estapé J, Salvador P, Jiménez de Anta M, Sanfeliú Sala I, Fontanals Aymerich D, Estivill Navarrete M, Morta M, Gené Giralt A, Latorre Otín C, Bosh J, Martín-Álvarez R, Lung M, Salvadó Costa M, Mirelis Otero B, Coll Figa P, San José Alemany C, Vilamala Bastarras A, Díaz de Tuesta del Arco J, Cisterna Cáncer R, Calvo Muro F, Elorduy Otazúa L, Corral Carranceja I, Martínez de la Fuente AP, López de Goikoetxea M, Blasco Molla A, Ojeda Fernández E, Gimeno Crespo C, Íñiguez Ovando R, Teno Sánchez P, Lozano Domínguez M, Fernández Gutiérrez del Alamo C, Sánchez Porto A, de Miguel Sastre C, Calbo Torrecillas L, Salesa Gutiérrez de Rozas R, Martínez Martínez L, Téllez Castillo C, Moreno Muñoz R, López Llopis A, Pesudo Calatayud S, López Barba J, Martínez Alarcón J, Torres Narbona M, Romero Aguilera M, Manrique González E, Carranza González R, Causse del Río M, Casal Román M, Seseña del Olmo G, Rodríguez Escudero M, Martínez Medina M, Liébana Ureña J, Maroto Vela M, Miranda Casas C, Navarro Mari J, Solís del Baño S, Bisquert Santiago J, Ubarrechea Rojo C, Jiménez Alfaro J, Gomáriz Díaz M, Pérez Trallero E, Saavedra Martín J, Mairal Claver M, Ferrero Cáncer M, Mena Ribas A, Déniz Naranjo C, Pérez Sáenz J, Sánchez Gómez J, Hurtado Fernández A, Domínguez Gómez D, Agulla Budiño JA, Álvarez Alba A, Castro Romero P, Velasco Fernández D, Villanueva González R, Ojeda Vargas M, Martín Sánchez A, López Medrano R, Fuster Foz C, Remacha A, Parras Padilla T, Cachón García F, Aramburu Arnuelos J, Nogues Biau A, Undabeitia E, Pita Carretero J, García-Garrote F, Alonso García M, Portús Marco M, Cortés R, García Blanco A, López-Brea M, Alcalá L, Martín A, Marín M, Sánchez-Somolinos M, Catalán P, Peláez T, Bouza E, Salto Fernández E, Rodríguez Otero J, Baquero Mochales M, Morosini Reilly M, Cantón Moreno R, Sánchez Romero I, Dámaso López D, Amor E, Bernaola Lorenzo C, Picazo JJ, García Bujalance S, Gutiérrez Altés A, de Urmeneta Rada MA, Cuadros González J, Beltrán Dubón M, Sánchez Concheiro M, González Torralba A, Alós JI, Merino Fernández FJ, Wilhelmi de Cal I, Delgado-Iribarren I, Valverde J, Pérez Pomata M, Gómez Garcés J, González Abad M, Menéndez Rivas M, Izquierdo Ruiz de la Peña MA, Hervás Maldonado F, Bermúdez Ruiz P, Porras Ballesteros J, Ortega Torres M, Pinedo Sánchez A, Navarro Madrid JC, Tejero García R, del Río Medel L, Blázquez Garrido R, Leiva León J, Navascúes Ortega A, Fernández Jaúregui C, Martínez de Artola V, Cid Lama A, Estebán Meruéndano G, Jaime Muniesa M, Rodríguez M, Álvarez García P, García Campello M, González Mediero G, González del Blanco T, Sevillano Castaño J, Rodríguez I, García García M, García Sánchez J, Sierra López A, Sánchez Flores M, Díez Gil O, Carrero González P, Hernando Real S, García Carbajosa S, Muñoz Nuño E, Pascual Hernández A, Perea E, Ruiz Pérez de Pipaón M, Aznar Martín J, Aller García A, Martín Mazuelos E, Nebreda Mayoral T, Campos A, Tapiol Oliva J, Santamaría J, Chocarro Escanero P, Ramos Germán F, Brea Zubicaray S, Zamarrón Fuertes P, Heredero Gálvez E, Ramos Reig P, Orta Mira N, Díaz Fernández J, Aparisi N, García Aguayo J, Yago M, Giner Almaraz S, Aznar Oroval E, Maiquez Richart J, Navarro Pérez L, Segarra Martínez C, Ferreruela Vicente R, García Lozano T, García de Lomas J, Mengual Buigues P, Hernández Tintorer J, González Granda D, Ochoa Ávila E, Bratos Pérez M, Órtiz de Lejarazu R, Gómez Nieto A, Arranz Peña M, Lorenzo Vidal B, Brezmes Valdivieso M, Miñana Amada C, Castillo García F, Rubio Calvo M, Omeñaca Terés M, Aísa Iriarte M, Revillo Pinilla M.

Author information

1
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain. luisalcala@efd.net

Abstract

Underdiagnosis of Clostridium difficile infection (CDI) because of lack of clinical suspicion or the use of non-sensitive diagnostic techniques is a known problem whose real magnitude has not yet been quantified. In order to estimate the extent of this underdiagnosis, we performed C. difficile cultures on all unformed stool specimens sent-irrespective of the type of request-to a series of laboratories in Spain on a single day. The specimens were cultured, and isolates were characterized at a central reference laboratory. A total of 807 specimens from 730 patients aged ≥ 2 years were selected from 118 laboratories covering 75.4% of the Spanish population. The estimated rate of hospital-acquired CDI was 2.4 episodes per 1000 admissions or 3.8 episodes per 10,000 patient-days. Only half of the episodes occurred in patients hospitalized for >2 days. Two of every three episodes went undiagnosed or were misdiagnosed, owing to non-sensitive diagnostic tests (19.0%) or lack of clinical suspicion and request (47.6%; mostly young people or non-hospitalized patients). The main ribotypes were 014/020 (20.5%), 001 (18.2%), and 126/078 (18.2%). No ribotype 027 strains were detected. Strains were fully susceptible to metronidazole and vancomycin. CDI was underdiagnosed in diarrhoeic stools in a high proportion of episodes, owing to the use of non-sensitive techniques or lack of clinical suspicion, particularly in people aged <65 years or patients with community-acquired diarrhoea. C. difficile toxins should be routinely sought in unformed stools of any origin sent for microbiological diagnosis. The ribotype 027 clone has not yet disseminated in Spain.

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