Impact of testing on Clostridioides difficile infection in hospitals across Europe: A mathematical model
Abstract
Objectives
Prevalence of Clostridioides difficile infection (CDI) has been shown to vary markedly between European countries, both in hospitals and the community. Determining the true prevalence has proven challenging. Without systematic testing in hospitals, the unchecked transmission of CDI can lead to large outbreaks in more susceptible cohorts. We investigate the success of CDI surveillance and control measures across Europe, by examining the dynamics of disease spread from the community into a hospital setting. We focus on national differences, such as variability in testing and sampling, disease prevalence in community and hospitals, and antimicrobial usage (AMU).
Methods
We developed a stochastic, compartmental, dynamic mathematical model parameterised using sampling and testing rate data from COMBACTE-CDI, a multi-country study in which all diarrhoeal stool samples (N=3163) from European laboratories were tested for CDI, and data for AMU and incidence of hospital cases sourced from the European Centre for Disease Prevention and Control.
Results
The framework estimates the prevalence of CDI among hospital patients across European countries and explores how national differences impact the dynamics, transmission and relative incidence of CDI within the hospital setting. The model illustrates the mechanisms influencing these national differences. Namely, AMU rates, national sampling and testing rates and community prevalence of CDI.
Conclusions
Differential costs for testing and practicalities of scaling up testing mean every country needs to consider, balancing CDI testing costs against costs of treatment and care of CDI patients.