Diversity of Clostridium difficile PCR ribotypes in Europe: results from the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID), 2012 and 2013

Clostridium difficile infection (CDI) is the major cause of infective diarrhoea in healthcare environments. As part of the EUCLID study, the largest C. difficile epidemiological study of its type, PCR-ribotype distribution of C. difficile isolates in Europe was investigated. PCR-ribotyping was performed on 1196 C. difficile isolates from diarrhoeal samples sent to the European co-ordinating laboratory in 2012–13 by 482 participating hospitals from 19 European countries. A total of 125 ribotypes were identified, of which ribotypes 027 (18.6%), 001/072 (11.2%) and 014 (7.0%) were the most prevalent. Distinct regional patterns of ribotype distribution were noted in Northern, Western, Southern and Eastern Europe. Of 596 isolates from patients with toxin-positive stools (confirmed CDI), ribotype 027 accounted for 27.8% of infections in patients aged 2–<65 years, but the prevalence decreased in those aged ≥65 years (14.3%) and further decreased in those aged ≥81 years (9.2%). The prevalence of ribotype 027 (but not other epidemic strains) was inversely proportional to overall ribotype diversity (R2=0.717). The EUCLID study highlights an increased diversity of C. difficile ribotypes across Europe compared with previous studies, with considerable inter-country variation in ribotype distribution. Continuous surveillance programmes are necessary to monitor the changing epidemiology of C. difficile