title: Reduction in Clostridium difficile infections in Finland, 2008-2010.
abstract: BACKGROUND
  In January 2008, laboratory-based surveillance of Clostridium difficile was initiated as a part of the Finnish National Infectious Disease Register (NIDR) and enhanced surveillance of hospitalized patients with C. difficile-associated infections (CDI) by the Finnish Hospital Infection Programme (SIRO).
  
  
  OBJECTIVE
  To present data from the first three years.
  
  
  METHODS
  All laboratories reported C. difficile findings positive for toxin production from stools to NIDR. Surveillance of hospitalized patients with CDI was conducted using the interim case definitions of the European Centre for Disease Prevention and Control for CDI, origin and severe case of CDI. In all, 16 acute care hospitals from 10 of the 21 healthcare districts (HDs) participated in SIRO during 2008-2010. Clinical microbiology laboratories were asked to send isolates from severe cases and persistent outbreaks to the national reference laboratory for genotyping.
  
  
  RESULTS
  The annual incidence rate of CDIs decreased by 24%, from 119 per 100,000 population in 2008 to 90 per 100,000 in 2010. The decrease occurred in 13/21 (62%) HDs (range of decrease by HD: 2-51%). The nosocomial rate decreased 26%, from 0.31 to 0.23 per 1000 patient-days, and occurred in about half of the hospitals that participated in SIRO. During 2008-2010, 17 HDs sent C. difficile specimens for typing. Ribotype 027 was found in eight HDs, all showing values above the mean or increasing population-based incidence rates of CDIs.
  
  
  CONCLUSIONS
  Population-based surveillance of CDIs and enhanced surveillance of nosocomial cases showed reduction in CDIs, but success in controlling the disease varied between regions.
authors.affiliation: Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare (THL), Helsinki, Finland. mari.kanerva@hus.fi
authors.forename: M
authors.initials: M
authors.lastname: Kanerva
authors.forename: S
authors.initials: S
authors.lastname: Mentula
authors.forename: A
authors.initials: A
authors.lastname: Virolainen-Julkunen
authors.forename: T
authors.initials: T
authors.lastname: Kärki
authors.forename: T
authors.initials: T
authors.lastname: Möttönen
authors.forename: O
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D021521:Ribotyping; D055815:Young Adult