title: Highlighting clinical needs in Clostridium difficile infection: the views of European healthcare professionals at the front line.
abstract: BACKGROUND
  Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea in Europe. Despite increased focus, its incidence and severity are increasing in many European countries.
  
  
  OBJECTIVE
  We developed a series of consensus statements to identify unmet clinical needs in the recognition and management of CDI.
  
  
  METHODS
  A consortium of European experts prepared a series of 29 statements representing their collective views on the diagnosis and management of CDI in Europe. The statements were grouped into the following six broad themes: diagnosis; definitions of severity; treatment failure, recurrence and its consequences; infection prevention and control interventions; education and antimicrobial stewardship; and National CDI clinical guidance and policy. These statements were reviewed using questionnaires by 1047 clinicians involved in managing CDI, who indicated their level of agreement with each statement.
  
  
  RESULTS
  Levels of agreement exceeded the 66% threshold for consensus for 27 out of 29 statements (93.1%), indicating strong support. Variance between countries and specialties was analysed and showed strong alignment with the overall consensus scores.
  
  
  CONCLUSIONS
  Based on the consensus scores of the respondent group, recommendations are suggested for the further development of CDI services in order to reduce transmission and recurrence and to ensure that appropriate diagnosis and treatment strategies are applied across all healthcare settings.
authors.affiliation: University Hospital 12 de Octubre, Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
authors.affiliation: Helsinki University and Helsinki University Hospital, Finland.
authors.forename: V J
authors.initials: VJ
authors.lastname: Anttila
authors.affiliation: Hôpital Claude Huriez, Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Galperine
authors.affiliation: Centre for Clinical Infection and Diagnostics Research, Guy's and St Thomas' NHS Foundation Trust, and King's College, London, UK. Electronic address: Simon.goldenberg@gstt.nhs.uk.
authors.forename: S D
authors.initials: SD
authors.lastname: Goldenberg
authors.affiliation: Triducive Ltd, St Albans, UK.
authors.forename: S
authors.initials: S
authors.lastname: Gwynn
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: D
authors.initials: D
authors.lastname: Jenkins
authors.affiliation: Örebro University Hospital, Örebro, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Norén
authors.affiliation: National Institute for Infectious Diseases, Rome, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Petrosillo
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Seifert
authors.affiliation: Department of Internal Medicine IV, Universitätsklinikum Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Stallmach
authors.affiliation: Triducive Ltd, St Albans, UK.
authors.forename: T
authors.initials: T
authors.lastname: Warren
authors.affiliation: Süd Kaiser Franz Josef Spital, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Wenisch
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D017408:Guidelines as Topic; D006282:Health Personnel; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000592:standards*; D020380:Needs Assessment; D011795:Surveys and Questionnaires
chemical_list: D000890:Anti-Infective Agents
keywords: Clostridium difficile; Consensus opinion; Delphi method