Reduction in Clostridium difficile infections in Finland, 2008-2010

Area of Science:

• Infectious Disease Epidemiology
• Public Health Surveillance
• Microbiology

Background:

• Initiation of laboratory-based Clostridium difficile surveillance in Finland in January 2008.
• Integration into the National Infectious Disease Register (NIDR) and enhanced surveillance of hospitalized patients with C. difficile-associated infections (CDI) via the Finnish Hospital Infection Programme (SIRO).

Purpose of the Study:

• To present surveillance data for Clostridium difficile infections (CDI) in Finland over the first three years (2008-2010).
• To assess the impact of national surveillance programs on CDI incidence and control.

Main Methods:

• Laboratory reporting of C. difficile toxin-positive stool findings to NIDR.
• Enhanced surveillance of hospitalized CDI cases using European Centre for Disease Prevention and Control definitions.
• Participation of 16 acute care hospitals across 10 healthcare districts (HDs) in the SIRO program.
• Genotyping of C. difficile isolates from severe cases and outbreaks by the national reference laboratory.

Main Results:

• Annual CDI incidence decreased by 24% (119 to 90 per 100,000 population) from 2008 to 2010, observed in 62% of HDs.
• Nosocomial CDI rate declined by 26% (0.31 to 0.23 per 1000 patient-days) in participating hospitals.
• Ribotype 027 was detected in eight HDs, often associated with above-average or increasing CDI incidence rates.

Conclusions:

• Population-based and enhanced surveillance demonstrated a reduction in CDI rates across Finland.
• The effectiveness of CDI control measures varied significantly among different healthcare regions.
• Continued monitoring and targeted interventions are necessary, especially in areas with prevalent C. difficile Ribotype 027.