European survey on the current surveillance practices, management guidelines, treatment pathways, and heterogeneity of testing of Clostridioides difficile, 2018-2019: results from The Combatting Bacterial Resistance in Europe CDI (COMBACTE-CDI)

Background

Awareness and compliance to international guidelines for diagnosis and clinical management of Clostridioides difficile infection (CDI) are unknown.

Aim

To compare the awareness and compliance with the recommended strategies for diagnosis and clinical management of CDI across Europe in 2018-2019.

Methods

Hospital sites and their associated community practices across 12 European countries completed an online survey in 2018-2019, to report on their practices in term of surveillance, prevention, diagnosis, and treatment of CDI. Responses were collected from 105 hospitals and 39 community general practitioners (GPs).

Findings

Hospital sites of 11 countries reported participation in national surveillance schemes compared to six countries for international schemes. The European Society of Clinical Microbiology and Infectious Diseases (ESCMID)-recommended CDI testing methodologies were used by 82% (86/105) of hospitals, however countries reporting the highest incidence of CDI used non-recommended test. Over 75% (80/105) of hospitals were aware of the most recent European CDI treatment guidelines at the time of this survey compared to only 26% (10/39) of surveyed GPs. However, up to 15% (16/105) of hospitals reported to use the non-recommended metronidazole for recurrent CDI cases, sites in countries with lower awareness of CDI treatment guidelines. Only 37% (39/105) of hospitals adopted contact isolation precautions in case of suspected CDI.

Conclusion

Good awareness of guidelines for the management of CDI was observed across the surveyed European hospital sites. However, low compliance with diagnostic testing guidelines, infection control measures for suspected CDI, and insufficient awareness of treatment guidelines were still reported in some countries.