title: Epidemiology and control of Clostridium difficile infections in healthcare settings: an update.
abstract: OBJECTIVE
  The epidemiology of Clostridium difficile infections (CDIs) has dramatically changed over the last decade in both North America and Europe. The objectives of this review are to highlight the recent epidemiological data and to provide an overview of the current knowledge of infection control measures.
  
  
  RESULTS
  Since 2003, many countries have reported increased incidence of CDI and outbreaks of severe cases of CDI. This trend is assumed to be due, in part, to the emergence and rapid spread of a 'hypervirulent' strain, known as 027/BI/NAP1. This strain has become endemic in many hospitals in North America and Europe. CDI rates have also increased in the community and new genotypes (e.g. PCR ribotype 078) are emerging in both humans and animals. To prevent cross-contamination and to reduce the incidence of CDI, infection control guidelines, based primarily on experience of hospitals during outbreaks, have been recently updated in Europe and the United States. CDI prevention relies on a bundle of measures including antimicrobial stewardship, prompt diagnosis, and the implementation of contact precautions. Currently, most of these measures have appeared effective in controlling outbreaks, but the best methods to reduce CDI incidence in settings of endemicity are still unknown.
  
  
  CONCLUSIONS
  The recent changes in CDI epidemiology have pushed infection control healthcare workers and scientific societies to revisit and update their guidelines for infection control.
authors.affiliation: National Reference Laboratory for Clostridium difficile, Pierre et Marie Curie University, Hôpital Saint-Antoine, UHLIN, Site Saint-Antoine, Paris, France. frederic.barbut@sat.aphp.fr
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Jones
authors.forename: Catherine
authors.initials: C
authors.lastname: Eckert
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D006268:Health Facilities; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011159:Population Surveillance
chemical_list: D000890:Anti-Infective Agents