Clinical and microbiological features of Clostridium difficile infections in France: the ICD-RAISIN 2009 national survey.

INTRODUCTION

The surveillance of Clostridium difficile infections (CDI) in France was reinforced after the emergence of the PCR-ribotype 027 epidemic clone in 2006; notification of case clusters or severe cases by healthcare facilities (HCF) became mandatory. The French Public Health Surveillance Institute (InVS) and the C. difficile National Reference Center (NRC) launched a national, prospective, multicentric survey to complete available data, in 2009. The survey had for objectives to assess CDI incidence and to characterize the strains responsible for CDI.

PATIENTS AND METHODS

Every month from March to August 2009, HCF notified the total number of new CDI cases, admissions, and patient-days (PD) to the InVS. A subset of participating HCF sent strains, isolated in March 2009 from CDI patients, to the NRC.

RESULTS

One hundred and five HCF with acute care wards and 95 with rehabilitation/long-term care (RLTC) wards participated in the 6-month epidemiological study. The incidence of CDI was 2.28 or 1.15 cases per 10,000 PD in acute care (n=1316 cases) or RLTC (n=295 cases), respectively. Seventy-eight HCF participated in the microbiological study. Two hundred and twenty-four (94.9%) of the 236 strains received by the NRC were toxigenic. The five major PCR-ribotypes were 014/020/077 (18.7%), 078/126 (12.1%), 015 (8.5%), 002 (8%), and 005 (4.9%).

CONCLUSION

The incidence of CDI in 2009 in France remained lower than in other European countries, suggesting a successful impact of the 2006 recommendations for CDI control.