European Parliament Urges Its Member States to Do More to Tackle Clostridium difficile Infection

Clostridium difficile infection (CDI) is a priority target for actions needed to improve patient safety in Europe, according to a resolution adopted by the European Parliament on Oct. 22, 2013.(1) The resolution argues that patient safety, and in particular the prevention and control of healthcare-associated infections (HAIs), should be near the top of the political agenda in the EU, both at national level in the member states and at regional and local levels.

The resolution was welcomed by the CDI Europe group of expert microbiologists and infectious disease physicians. Focused on driving change at a policy level, this group aims to translate research on CDI into meaningful policy responses to help promote a better standard of care for CDI management across Europe and ultimately to improve patient outcomes.(2)

HAIs are a growing concern in health systems throughout the world, including in Europe. According to an explanatory statement to the Parliamentary resolution, an estimated 5 percent of patients in hospitals, or 3.2 million people annually, contract HAIs each year and these infections are directly responsible for 37,000 deaths.(1) CDI accounts for about 5 percent of all HAIs in Europe and is becoming increasingly common in many countries. CDI is estimated to confer a financial burden of Euro 3,700 million annually.(2)

Led by Italian Member of European Parliament (MEP), Oreste Rossi, the Parliamentary resolution welcomes work conducted by the European Commission and the European Centre for Disease Control and Prevention (ECDC), in conjunction with health authorities in the member states, on preventing and combatting HAIs.

Dr. Nicola Petrosillo, director of the Second Infectious Diseases Unit, L. Spallanzani National Institute for Infectious Diseases in Rome, Italy, says, In many European countries, recently, an increase of CDI cases has been observed. As an example, the increasing rate of CDI episodes in Italian hospitals over the last six years represents a matter of concern, and the emergence of hyper-virulent strains, already circulating in Italy, is a cause of further worry. An urgent need for improvement in the surveillance system, in education for raising CDI suspicion, and infection control programs, including antimicrobial stewardship strategies, is therefore advisable.

Measures taken at EU level include the ECDCs support of capacity building for laboratory surveillance systems for CDI (ECDIS-Net) and its development of guidance for CDI prevention and control. However only 13 member states have implemented national surveillance of Clostridium difficile infections and in only three of these surveillance systems are general practitioners also involved in the data collection a situation that should be improved according to the resolution.(1)

According to professor Ed J. Kuijper, president of European Study group of C. difficile (ESGCD), and co-ordinator of the ECDIS-Net surveillance network (Department of Medical Microbiology, Leiden University Medical Centre, Leiden, Netherlands), "The importance of continuous surveillance for CDI with involvement of national institutes and reference laboratories is illustrated by recent findings of a re-emergence of the more virulent C. difficile Type 027 in some European countries. CDI is also an important disease in animals; the pan-European increase of C. difficile Type 078 in diarrheal piglets and patients with community-acquired diarrhea, suggests that this type has crossed the species border. 
      
Generally, some measures recommended by the European Council in 2009 to prevent and combat HAIs have been implemented in only a limited number of member states, and further progress is still possible, particularly in the provision of information to patients and support for research into the prevention and control of HAIs.

The resolution urges member states to set clear national targets for the reduction of HAIs, and to implement (if they have not already done so) additional measures to achieve this in line with the European Councils recommendations of 2009. In particular, measures are needed to:
- Prevent HAIs both inside and outside hospitals by the systematic implementation of the One Health approach, whereby both medical and veterinary professionals undertake to prevent resistant infections and reduce the use of antibiotics
- Improve the information provided to patients by healthcare establishments, including information on the prevalence of HAIs in those establishments
- Support research into the prevention and control of HAIs, particularly those caused by C  difficile, methicillin-resistant Staphylococcus aureus (MRSA) and other emerging difficult-to-treat infections.(1)

Commenting on the European Parliament vote, professor Mark Wilcox at the University of Leeds and Leeds Teaching Hospitals, says, CDI can be a major threat to patients and to healthcare systems. It requires a co-ordinated approach to minimize patient risk, and this starts with ensuring that the diagnosis and surveillance of CDI is optimized. We already know that there is a wide disparity across Europe in how efficient we are at detecting CDI. Potentially wrong diagnoses in approximately one-quarter of patients with CDI may lead to inappropriate or sub-optimal treatment or inadequate infection control measures.(3)

References
1. European Parliament. Report on the report from the Commission to the Council on the basis of Member States' reports on the implementation of the Council Recommendation (2009/C 151/01) on patient safety, including the prevention and control of healthcare-associated infections (2013/2022(INI)) Committee on the Environment, Public Health and Food Safety. (Rapporteur: Oreste Rossi)
2. CDI Europe. Clostridium difficile infection in Europe. A CDI Europe Report. April 2013. [http://www.epgonline.org/anti-infectives-knowledge-network/a-cdi-europe-report.cfm ]
3. Davies KA, Longshaw CM, Davis GL, et al. First report from EUropean, multicentre, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalised patients with Diarrhoea (EUCLID). 23rd European Congress on Clinical Microbiology and Infectious Diseases, Berlin, 2730 April 2013. Abstract LB2968