Clostridium difficile infection (CDI) is a potentially fatal bacterial infection that causes inflammation of the colon and leads to 3,700 deaths a year in Europe.1
C. difficile infection is highly symptomatic, causing abdominal cramping, diarrhea, fever, mucus or blood in stool, and elevated white blood cell levels. Despite these pronounced and serious symptoms, patients often are not tested for C. difficile. In fact, almost two-thirds of CDI cases are missed because clinicians fail to request tests for C. difficile toxins in cases of unexplained diarrhea, underscoring that much more must be done to stop the spread of this dangerous infection.2
There are various systemic reasons for the underscreening of CDI. Half of all European hospitals screen for CDI only at the request of the physician.3 Diagnostic strategies that involve testing only upon physician request underestimate the prevalence of C. difficile.4 A recent study showed that 82 patients with CDI were not diagnosed across Europe on a single day; this equates to more than 39,000 missed diagnoses each year across the continent.5 Moreover, more than half of hospitals still do not use the most accurate testing procedure for CDI and more than one in five samples found to be positive for CDI by study investigators had not been tested at the local hospital level.6
When [C. difficile Infection] remains undiagnosed and untreated, it not only endangers patients’ health, it also poses a serious cost to healthcare systems.
When CDI remains undiagnosed and untreated, it not only endangers patients’ health, it also poses a serious cost to healthcare systems. In Europe, the potential cost of CDI is estimated to be €3 billion for each year — and is expected to almost double over the next four decades.7 CDI has an enormous impact on healthcare systems as infected patients are often hospitalized an extra one to three weeks at an additional cost of up to €14,000, compared with patients without CDI.8 As the incidence and severity of CDI continues to increase, it is essential that CDI testing practices in hospitals improve.
Leading medical organizations are starting to address this lack of screening with new guidelines. For example, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) recently made important updates to their guidelines on diagnosis of CDI.9 Among them, the guidelines include a new recommendation for empiric testing of all unformed stool samples for patients over three years old. ESCMID also recommends that a follow-up Toxin A/B test be used to validate a positive result from a molecular test for optimal specificity and sensitivity of results. Fortunately, there exist rapid tests today that integrate both components so that healthcare professionals can accurately diagnose CDI and immediately administer appropriate treatment.
Other regions that face challenges with diagnosis of CDI are beginning to adopt this testing protocol. In the United States, where the majority of hospitals use molecular tests to diagnose CDI, often as stand-alone tests, there is a movement towards adopting ESCMID’s guidelines. CDI is linked to about 30,000 deaths a year in the United States — about twice federal estimates and rivaling the 32,000 killed in traffic accidents.10 Hospitals in the U.S. and other countries should look to these guidelines as a roadmap to help control the spread of CDI and stop the avoidable deaths caused by this dangerous infection.