Ninth Annual Report of the National Reference Laboratory for Clostridium difficile and results of the sentinel surveillance
The National Reference Laboratory for C. difficile
The National Reference Laboratory coordinates a sentinel
surveillance program with 22 participating acute care hospitals in
the Netherlands, and performs molecular characterisation of C.
difficile in cases of severe C. difficile infections (CDI) or
suspected outbreaks (‘ad hoc typing service’) for other healthcare
The Reference Laboratory is now able to recognize 204 different
Results of the sentinel surveillance (May 2014- May 2015)
A mean incidence rate of 2.98 CDI per 10.000 patient-days was
found through sentinel surveillance (varying between hospitals from
0.92 to 5.56 CDI per 10.000 patient-days), similar to last
The disease severity was reported for 806 out of 931 patients
included in the surveillance; 24% had severe CDI. The 30-day
outcome was reported for 715 patients; 0.1% and 1.1% of the
patients needed surgery or were admitted to the ICU due to CDI,
12.6% of the patients died within 30 days (n=90), of which 31
patients (4.3%) known to be contributable to CDI.
No outbreaks were observed in the participating hospitals.
The most frequent encountered PCR ribotypes included ribotype
014/020 (16.3%), the closely related ribotypes 078 and 126 (12.9%),
and ribotype 002 (7.1%). The proportion of ribotype 001 decreased
from 26.5 to 5.9% over a period of six years.
Ribotype 027 was less abundant than in the last five years
(0.7% compared to 2.3-4.2%).
Results of ad hoc typing (May 2014- May 2015)
Eleven healthcare facilities/laboratories sent 133 strains to
the Reference Laboratory for ad hoc typing because of outbreaks,
severe CDI cases, or for other reasons.
Ribotype 027 was the predominant ribotype, found in 14.3%,
followed by ribotype 078/126 (13.3%).
One 027 outbreak was observed in the North-Western part of the
Netherlands, whereas five 027 outbreaks were reported in 2013-2014.
Some 027 cases in surrounding nursing homes were detected as well.
An outbreak management team was able to rapidly control the
outbreak, and the local public health service was consulted to
coordinate C. difficile-related measures in surrounding nursing
Burden of CDI in the Netherlands
Extrapolating the data of sentinel surveillance to all
hospitals in the Netherlands (with a total of 9.400.000
patient-days per year1), it is estimated that approximately 2800
hospitalized patients will develop CDI, and 120 patients succumb
contributable to CDI annually. In these estimations, the impact of
CDI in other healthcare facilities than hospitals is not
We observed a substantial decrease of the burden of ribotype
027 compared to the prior year.