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      Trends in the epidemiology of Clostridioides difficile infection in Germany

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          Abstract

          Purposes

          Despite reports of a declining incidence over the last decade, Clostridioides difficile infection (CDI) is still considered the most important healthcare-associated causes of diarrhea worldwide. In Germany, several measures have been taken to observe, report, and influence this development. This report aims to analyze the development of hospital coding for CDI in Germany over the last decade and to use it to estimate the public health burden caused by CDI.

          Methods

          Reports from the Institute for Hospital Remuneration Systems, German Federal Statistical Office (DESTATIS), the Robert-Koch-Institute (RKI), Saxonian authorities and hospital quality reports during 2010–2021 were examined for CDI coding and assessed in a structured expert consultation. Analysis was performed using 2019 versions of Microsoft Excel® and Microsoft Access®.

          Results

          Peaks of 32,203 cases with a primary diagnosis (PD) of CDI and 78,648 cases with a secondary diagnosis (SD) of CDI were observed in 2015. The number of cases had decreased to 15,412 PD cases (− 52.1%) and 40,188 SD cases (− 48.9%) by 2021. These results were paralleled by a similar decline in notifiable severe cases. However, average duration of hospitalization of the cases remained constant during this period.

          Conclusions

          Hospital coding of CDI and notification to authorities has approximately halved from 2015 to 2021. Potential influential factors include hospital hygiene campaigns, implementation of antibiotic stewardship programs, social distancing due to the COVID-19 pandemic, and a decrease in more pathogenic subtypes of bacteria. Further research is necessary to validate the multiple possible drivers for this development.

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          Most cited references47

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          Multistate point-prevalence survey of health care-associated infections.

          Shelley Magill, Jonathan R Edwards, Wendy Bamberg … (2014)
          Currently, no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient populations. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate updated estimates of the national burden of such infections. We defined health care-associated infections with the use of National Healthcare Safety Network criteria. One-day surveys of randomly selected inpatients were performed in participating hospitals. Hospital personnel collected demographic and limited clinical data. Trained data collectors reviewed medical records retrospectively to identify health care-associated infections active at the time of the survey. Survey data and 2010 Nationwide Inpatient Sample data, stratified according to patient age and length of hospital stay, were used to estimate the total numbers of health care-associated infections and of inpatients with such infections in U.S. acute care hospitals in 2011. Surveys were conducted in 183 hospitals. Of 11,282 patients, 452 had 1 or more health care-associated infections (4.0%; 95% confidence interval, 3.7 to 4.4). Of 504 such infections, the most common types were pneumonia (21.8%), surgical-site infections (21.8%), and gastrointestinal infections (17.1%). Clostridium difficile was the most commonly reported pathogen (causing 12.1% of health care-associated infections). Device-associated infections (i.e., central-catheter-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which have traditionally been the focus of programs to prevent health care-associated infections, accounted for 25.6% of such infections. We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011. Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections. As device- and procedure-associated infections decrease, consideration should be given to expanding surveillance and prevention activities to include other health care-associated infections.
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            Burden ofClostridium difficileInfection in the United States

            Fernanda Lessa, Yi Mu, Wendy Bamberg … (2015)
            The magnitude and scope of Clostridium difficile infection in the United States continue to evolve.
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              Clostridium difficile infection

              Wiep Klaas Smits, Dena Lyras, D. Borden Lacy … (2016)
              Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota.
              Article 0 comments Cited 304 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Maria Johanna Gobertina Tetuanui Vehreschild:
                ORCID: http://orcid.org/0000-0003-0446-3224
                Maria.Vehreschild@kgu.de
                Stefan Schreiber: s.schreiber@mucosa.de
                Lutz von Müller: lutz.mueller@christophorus-kliniken.de
                Hans-Jörg Epple: hans-joerg.epple@charite.de
                Thomas Weinke: th.weinke@gmail.com
                Carolin Manthey:
                ORCID: http://orcid.org/0000-0002-5340-491X
                manthey@gim-witten.de
                Jun Oh: j.oh@uke.de
                Steffen Wahler:
                ORCID: http://orcid.org/0000-0003-4833-7449
                steffen.wahler@stbernward.de
                Andreas Stallmach:
                ORCID: http://orcid.org/0000-0002-6101-5244
                Andreas.Stallmach@med.uni-jena.de
                Journal
                Journal ID (nlm-ta): Infection
                Journal ID (iso-abbrev): Infection
                Title: Infection
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0300-8126
                ISSN (Electronic): 1439-0973
                Publication date (Electronic): 10 May 2023
                Pages: 1-8
                Affiliations
                [1 ]GRID grid.411088.4, ISNI 0000 0004 0578 8220, Universitätsklinikum Frankfurt, ; Medizinische Klinik 2, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
                [2 ]GRID grid.412468.d, ISNI 0000 0004 0646 2097, Department Medicine I, , University Hospital Schleswig-Holstein, Christian-Albrechts-University, ; Rosalind-Franklin-Str. 12, 24105 Kiel, Germany
                [3 ]GRID grid.473516.2, Christophorus-Kliniken GmbH, ; Südring 41, 48653 Coesfeld, Germany
                [4 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Antibiotic Stewardship, ; Hindenburgdamm 30, 12203 Berlin, Germany
                [5 ]Ernst Von Bergmann Klinikum gGmbH, Charlottenstraße 72, 14467 Potsdam, Germany
                [6 ]Gemeinschaftspraxis Innere Medizin (GIM), Pferdebachstr. 29, 58455 Witten, Germany
                [7 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Universitätsklinikum Hamburg-Eppendorf, ; Martinistraße 52, 20246 Hamburg, Germany
                [8 ]St. Bernward GmbH, Friedrich-Kirsten-Str. 40, 22391 Hamburg, Germany
                [9 ]GRID grid.275559.9, ISNI 0000 0000 8517 6224, Klinik Für Innere Medizin IV, , Universitätsklinikum Jena, ; Am Klinikum 1, 07747 Jena, Germany
                Author information
                http://orcid.org/0000-0003-0446-3224
                http://orcid.org/0000-0002-5340-491X
                http://orcid.org/0000-0003-4833-7449
                http://orcid.org/0000-0002-6101-5244
                Article
                Publisher ID: 2044
                DOI: 10.1007/s15010-023-02044-5
                PMC ID: 10170422
                PubMed ID: 37162717
                SO-VID: 6182ecd1-329d-403b-948d-7106e0b0c3c3
                Copyright © © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 16 April 2023
                Date accepted : 25 April 2023
                Funding
                Funded by: Ferring Arzneimittel GmbH
                Categories
                Subject: Research

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: epidemiology,clostridioides difficile,infection,incidence,germany
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: epidemiology, clostridioides difficile, infection, incidence, germany

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