The increasing incidence of Clostridium difficile infections (CDI) in healthcare settings in Europe since 2003 has affected both patients and healthcare systems. The implementation of effective CDI ...surveillance is key to enable monitoring of the occurrence and spread of C. difficile in healthcare and the timely detection of outbreaks.
The aim of this review is to provide a summary of key components of effective CDI surveillance and to provide some practical recommendations. We also summarize the recent and current national CDI surveillance activities, to illustrate strengths and weaknesses of CDI surveillance in Europe.
For the definition of key components of CDI surveillance, we consulted the current European Society of Clinical Microbiology and Infectious Diseases (ESCMID) CDI-related guidance documents and the European Centre for Disease Prevention and Control (ECDC) protocol for CDI surveillance in acute care hospitals. To summarize the recent and current national CDI surveillance activities, we discussed international multicentre CDI surveillance studies performed in 2005–13. In 2017, we also performed a new survey of existing CDI surveillance systems in 33 European countries.
Key components for CDI surveillance are appropriate case definitions of CDI, standardized CDI diagnostics, agreement on CDI case origin definition, and the presentation of CDI rates with well-defined numerators and denominators. Incorporation of microbiological data is required to provide information on prevailing PCR ribotypes and antimicrobial susceptibility to first-line CDI treatment drugs. In 2017, 20 European countries had a national CDI surveillance system and 21 countries participated in ECDC-coordinated CDI surveillance. Since 2014, the number of centres with capacity for C. difficile typing has increased to 35 reference or central laboratories in 26 European countries.
Incidence rates of CDI, obtained from a standardized CDI surveillance system, can be used as an important quality indicator of healthcare at hospital as well as country level.
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In this study, the low molecular weight lypophilic metabolites of C. albicans and C. dubliniensis strains produced in a synthetic medium with the addition of fetal calf serum were identified using ...LC/MS and MS/MS technique and quantified. All strains investigated produce a metabolite with a UV spectra maximum at 224 and 279 nm and minimum at 243 nm. Following comparison with ESI, MS/MS spectral data of a reference compound, the metabolite was identified as 3-indoleethanol (tryptophol). The concentration of extracellular tryptophol in the biosynthesis of C. albicans and C. dubliniensis ranged from 2.45 microg/mL to 191 microg/mL, respectively. Contrary to previously published data, gliotoxin or gliotoxin-like compounds were not detected, and all investigated C. albicans and C. dubliniensis strains have the same metabolite profile. Cytotoxic effects of tryptophol and 3-indolelactic acid (precursor of tryptophol biosynthesis) were cell-line-dependent. The EC50 of tryptophol ranged between 2 and 7 mM, with the EC50 of 3-indolelactic acid approximately double (between 4 and 8 mM). Tryptophol exhibited cell-type dependent cytotoxicity in relatively high concentrations, with domination of apoptosis.
Campylobacteriosis, salmonellosis and avian chlamydiosis are zoonotic diseases in which birds have been suggested to play an important role as reservoirs. We have investigated the prevalence of ...Campylobacter and Salmonella spp. and Chlamydophila sp. in 107 free-living birds belonging to 25 species from 13 families from Croatia in order to examine the natural infections caused by these agents. Campylobacter jejuni-like organisms were isolated from 2 of 107 free-living bird species examined (1.9%). Salmonella was isolated from 8 fresh fecal specimens from free-living bird species (7.4%). These isolates were identified as S. typhimurium in 4 (3.7%), and S. enteriditis in 4 (3.7%) free-living birds. These samples originated from feral pigeons (Columba livia domesticus; n=14; 28.6%), rook (Corvus frugilegus; n=13; 15.4%), buzzard (Buteo buteo; n=12; 16.7%), black-headed gull (Larus ridibundus; n=8; 12.5%) and tawny owl (Strix aluco; n=8; 12.5%). The presence of Chlamydophila sp. was not detected in the free-living birds examined during this study. Epidemiological aspects and possible significance of the examined birds as a source of infections for domestic animals and humans are discussed.PUBLICATION ABSTRACT
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