title: Survey of diagnostic and typing capacity for Clostridium difficile infection in Europe, 2011 and 2014.
abstract: Suboptimal laboratory diagnostics for Clostridium difficile infection (CDI) impedes its surveillance and control across Europe. We evaluated changes in local laboratory CDI diagnostics and changes in national diagnostic and typing capacity for CDI during the European C. difficile Infection Surveillance Network (ECDIS-Net) project, through cross-sectional surveys in 33 European countries in 2011 and 2014. In 2011, 126 (61%) of a convenience sample of 206 laboratories in 31 countries completed a survey on local diagnostics. In 2014, 84 (67%) of these 126 laboratories in 26 countries completed a follow-up survey. Among laboratories that participated in both surveys, use of CDI diagnostics deemed 'optimal' or 'acceptable' increased from 19% to 46% and from 10% to 15%, respectively (p  < 0.001). The survey of national capacity was completed by national coordinators of 31 and 32 countries in 2011 and 2014, respectively. Capacity for any C. difficile typing method increased from 22/31 countries in 2011 to 26/32 countries in 2014; for PCR ribotyping from 20/31 countries to 23/32 countries, and specifically for capillary PCR ribotyping from 7/31 countries to 16/32 countries. While our study indicates improved diagnostic capability and national capacity for capillary PCR ribotyping across European laboratories between 2011 and 2014, increased use of 'optimal' diagnostics should be promoted.
authors.affiliation: Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: Sofie M
authors.initials: SM
authors.lastname: van Dorp
authors.forename: Daan W
authors.initials: DW
authors.lastname: Notermans
authors.forename: Jeroen
authors.initials: J
authors.lastname: Alblas
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Silja
authors.initials: S
authors.lastname: Mentula
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Nagy
authors.forename: Patrizia
authors.initials: P
authors.lastname: Spigaglia
authors.forename: Katiusha
authors.initials: K
authors.lastname: Ivanova
authors.forename: Fidelma
authors.initials: F
authors.lastname: Fitzpatrick
authors.forename: Frédéric
authors.initials: F
authors.lastname: Barbut
authors.forename: Trefor
authors.initials: T
authors.lastname: Morris
authors.forename: Mark H
authors.initials: MH
authors.lastname: Wilcox
authors.forename: Pete
authors.initials: P
authors.lastname: Kinross
authors.forename: Carl
authors.initials: C
authors.lastname: Suetens
authors.forename: Ed J
authors.initials: EJ
authors.lastname: Kuijper
mesh_terms: D002984:Clinical Laboratory Information Systems; D019411:Clinical Laboratory Techniques / Q000379:methods*; D016360:Clostridioides difficile / Q000235:genetics* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007753:Laboratories; D016133:Polymerase Chain Reaction / Q000379:methods*; D011159:Population Surveillance / Q000379:methods*; D021521:Ribotyping; D011795:Surveys and Questionnaires
keywords: Clostridium difficile; Clostridium infections in humans; diagnosis; laboratory; survey; typing