title: Underestimation of Clostridium difficile infection among clinicians: an international survey.
abstract: The objective of this investigation was to document clinicians' awareness regarding the incidence and severity of Clostridium difficile-associated diarrhea (CDAD). An international electronic survey was conducted among corresponding authors of articles indexed by PubMed and published during the last 10 years in 'Core Clinical Journals'. A total of 1,163 clinicians answered (response rate 59%); most of the responses were submitted from North America (54.6%), Europe (32.2%), and Asia/Pacific (11.6%). Only 2.2% of the participants answered correctly all four questions, while 14.1% answered all questions incorrectly. Regarding each question, 10.8% of the participants correctly estimated current CDAD treatment failure or recurrence rates to be around 40%, 33.4% correctly estimated the ratio of antibiotic-associated colitis attributed to C. difficile to be around 60%, 72.7% correctly responded that almost all antibiotics are associated with CDAD, and 41.7% correctly responded that any patient is at risk for CDAD. Almost half (44.4%) of the respondents considered CDAD to be underestimated. Participants from North America scored higher than those from Europe or Asia/Pacific (p < 0.001). Participants considering CDAD to be overestimated (3.4%) had the lowest mean score of correct answers. Among a clinically diverse international sample of physicians with academic expertise, there was an inadequate level of awareness of the magnitude and clinical importance of CDAD.
authors.affiliation: Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23, Marousi, Athens, Greece.
authors.forename: M N
authors.initials: MN
authors.lastname: Mavros
authors.forename: V G
authors.initials: VG
authors.lastname: Alexiou
authors.forename: K Z
authors.initials: KZ
authors.lastname: Vardakas
authors.forename: K
authors.initials: K
authors.lastname: Tsokali
authors.forename: T A
authors.initials: TA
authors.lastname: Sardi
authors.forename: M E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001208:Asia; D001291:Attitude of Health Personnel; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000139:chemically induced* / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D003092:Colitis / Q000139:chemically induced* / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D005060:Europe; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009656:North America; D010820:Physicians; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents