It has always lived up to its ominous species name: Clostridium difficile. It is difficult to culture, for example, and for this reason had for decades almost exclusively occupied hard-core devotees of anaerobic bacteria. In the 2000s, it also proved difficult to handle: outbreaks in hospitals began to be reported with increasing frequency in Europe and North America.
Hypervirulent strains belonging to ribotype 027, and to a lesser extent 078, emerged that caused high morbidity and mortality among those infected, reviewed in. Awareness rapidly increased and typing methods were fine-tuned. Investigations into risk factors for infection eventually led to identification of promising control measures, such as prudent antimicrobial drug stewardship, especially for those in risk groups.
The fact that the increase in frequency and severity of C. difficile infections was international led to discussions on the need to harmonise – and, if possible, standardise – methods and approaches for surveillance, diagnosis and strain typing. Two previous European reports provide the background to the work presented in the six papers forming this special issue of Eurosurveillance. These Europe-wide surveillance studies reported an increase in the mean incidence of C. difficile infections from 2.45 cases per 10,000 patient-days per hospital in 2005 to 4.1 in 2008 per 10,000 patient-days per hospital.
The special issue now at hand presents a mosaic of approaches, from an updated mapping of ‘the European territory’ to focused country-specific studies. What follows in this editorial is primarily a critical reading of the data, concentrating more on points that this author deems worthy of improvement or further attention.