Combatting bacterial resistance in Europe – Clostridioides difficile infection
COMBACTE-CDI's primary goal is to develop a detailed understanding of the epidemiology and clinical impact of Clostridioides difficile infection across Europe. The ultimate goal is to contribute to improved prevention and treatment options for such infections that are responsible for extensive morbidity, mortality and health care costs.

The 3-year COMBACTE-CDI project merges European expertise on clinical, diagnostic and therapeutic issues related to C. difficile infection (CDI). It brings together experts that previously have partnered in large international CDI projects, such as EUCLID, LUCID, ORCHID and ECDIS-NET, and combines all that knowledge with CLIN-Net and LAB-Net, the largest IMI-funded existing clinical and laboratory networks in Europe for carrying out challenging epidemiological and interventional studies. Add to the sum EPI-Net, a network mapping all European surveillance activities related to antimicrobial resistance. The combination of all these parties has invigorating potential. It is an ideal platform to extend our knowledge of this key infection, and ultimately to help with the development of better management modalities.

A collaborative approach comprising three scientific work packages (WPs):

  • A large epidemiology study will be undertaken across Europe in WP1 to quantify the burden of CDI (incidence, distribution, recurrence, morbidity, mortality, transmission) across the whole healthcare economy;
  • A case/control study in WP2, which along with data collected in a questionnaire will enable the consortium to assess current practices in Europe (guidelines, testing, surveillance, treatment, cost) and their potential impacts;
  • WP3 will create a rich, European, research platform that will provide support for future proof-of-concept and clinical studies of new prevention and treatment strategies for CDI.

The three interrelated research WPs will be supported by a management work package (WP4).

Clostridioides difficile infection

CDI is one of the most prevalent healthcare associated infections, affecting both hospitalized patients and individuals in the community; notably, there is an increasing realization that cases also occur in subjects not recently exposed to healthcare interventions, including antibiotics. CDI poses an extensive burden of morbidity, mortality and healthcare resource utilization, and so requires effective prevention and management strategies. Epidemiological data are, however, limited and studies typically have examined only part of a healthcare economy and usually have been focused on single countries/healthcare systems. Thus, there is a lack of robust, comprehensive data on the impact of CDI across countries in Europe. Furthermore, we know that large variations in the frequency of testing and the sensitivity of CDI diagnostics across European countries mean that the size of the problem is underestimated.

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Clinical trials

Within COMBACTE-CDI the following clinical studies are being executed:

WP1 - Epidemiology

A large epidemiology study will be undertaken across Europe in WP1-Epidemiology to quantify the burden of CDI. This will collect data on incidence, distribution, recurrence, morbidity, mortality and transmission across the whole health care economy. Performed in collaboration with GlaxoSmithKline Biologicals and bioMérieux.

WP2 - Current Practices

WP1 will be followed by a survey in WP2-Current practices. The data collected in a questionnaire will enable the consortium to assess current practices in Europe and their potential impacts, including guidelines, testing, surveillance, treatment and costs, with an aim to develop a best practice model. Performed in collaboration with bioMérieux.

Management board

From left to right: Dr. Philippe Cleuziat (bioMérieux), Prof. Dr. Marc Bonten (UMC Utrecht), Dr. Chris Webber (Pfizer)


Project management office

From left to right: Dr. Sebastian Heimann (University Hospital Cologne), Dr. Ron de Winter (UMC Utrecht), Anthony Benson (University of Leeds), Georgina Davis (University of Leeds), Dr. Ram Venkatachalam (UMC Utrecht), Dr. Philippe Cleuziat (bioMérieux), Claire-Marie Martis (UMC Utrecht)