European CDI Surveillance Systems under the Magnifying Glass

EPI-Net, COMBACTE-MAGNET’s epidemiology network, was conceptualized as one platform, integrating surveillance data from humans and animals in Europe, providing up-to-date information on prevalence and incidence of antimicrobial resistance and healthcare associated infections. By liaising with COMBACTE-CDI, Epi-Net aimed to contribute to the CDI research, mapping all CDI surveillance systems included in the EPI-Net repository (28 EU pre-Brexit and 4 EFTA countries) and to assess the quality of reporting.

Retrieved data indicates that mandatory and voluntary reporting of CDI in Europe is still extremely heterogeneous in hospitalized patients (only 12 countries have mandatory reporting for hospital-acquired CDI) and almost inexistent in community. From the well-organized mandatory CDI surveillance system Saxony (Germany), data shows that CDI enteritis are about 30 times more prevalent than life threatening cases further underlying the need for combined community and hospital surveillance. From February 2020 the COVID-19 pandemic had a strong impact on research targets of our team.

EPI-Net is exploring how change in antibiotic usage in community (e.g. due to reduced number of visits by primary care) had an impact on the incidence of community acquired CDI. Another focus is to analyze the variation of national antibiotic usage to define how this change in the epidemiological scenario impacted on the CDI incidence in healthcare settings. The team is aware that many confounders, such as variation of hand hygiene adherence, change in infection control procedures (including environmental cleaning protocols), and shortage of infection control dedicated personnel deviated to the COVID-19 management, have a role in driving the current CDI incidence but is confident that the knowledge of how these variations impacted on CDI could inform future preventive policy.