A new Clostridium difficile strain in Europe Petra Gastmeier Hanover Medical University German Natio

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A new Clostridium difficile strain in
EuropePetra GastmeierHanover Medical
University German National Center Reference for
Surveillance of Nosocomial Infections
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C. difficile A new strain
Pepin et al. CMAJ 2005
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Pepin et al. CMAJ 2005
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C. difficile A new strain
McDonald et al. New Engl J Med 2005
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Epidemiology in UK
Health Protection Agency (http//www.hpa.org)
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Epidemiology in Germany
But no R 027 strain until now !
Vonberg RP et al. EID 2007
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ECDC recommendations for preventing CDAD

• Extensive literature search
• Production of a first draft in June 2006
• Draft was sent to experts from 6 countries with
  experience with O27 for comments
• Expert meeting in Stockholm in January 2007
• Production of a revised draft
• Revised draft was send to the ECDC advisory
  board for comments (all European countries)
• Final version

Vonberg et al. submitted 2007
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Categories for implementation in clinical practice
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Example ISOLATION PRECAUTIONS
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Diagnosis of CDAD
UK Testing for C.difficile in each case of
diarrhoea in patients above 60 years since 2004,
meanwhile each case in patients above 2 years
old The Netherlands Testing for C.difficile in
each case of diarrhoea in a patients after the
third day of stay in the hospital
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Disinfection

• Spread by spores
• Hand disinfection is not useful, washing with
  soap and water
• Disinfection of the environment with
  hypochloride compounds

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Relationship between MRSA and C.difficile in
England (2004-2006)Results from a National
Surveillance System

• 172 trust are providing data for both pathogens
• About 7,000 cases of MRSA bacteraemia annually
• 51,690 CDAD cases in 2005
• Assessing the relationship by using the
  non-parametric Spearman correlation
• Result strong relationship between both types of
  infection (Spearman correlation 0.69 in 2005 and
  2006 Spearman correlation 0.71 in 2004)

Murray et al. , SHEA meeting Baltimore 2007
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Relationsship between MRSA and C.difficile in
England (2004-2006)Results from a national
Surveillance system

• Conclusion
• While the mechanisms of infection are generally
  quite different between MRSA and C.difficile, it
  appears that hospital-infection control measures
  are quite similar within trusts

Murray et al. , SHEA meeting Baltimore 2007