scholarly journals Burden of Clostridium difficile Infection (CDI) Across Whole Healthcare Economies and European Borders; COMBACTE-CDI Results

2020 ◽  
Vol 41 (S1) ◽  
pp. s24-s25
Author(s):  
Kerrie Davies ◽  
Virginie Viprey ◽  
Duncan Ewin ◽  
William Spittal ◽  
Jon Vernon ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Eastern Europe ◽  
Food Sources ◽  
Community Settings ◽  
Fecal Samples ◽  
Healthcare Facilities ◽  
Testing Rate ◽  
Inpatient Settings ◽  
Pcr Ribotyping ◽  
The Eu

Background: The burden of C. difficile infection (CDI) on healthcare facilities is well recognized. However, studies focusing on inpatient settings, in addition to ascertainment bias in general, have led to a paucity of data on the true burden of CDI across whole healthcare economies. Methods: Sites testing both inpatient and community samples were recruited from 12 European countries (1 site per 3 million population). On 2 selected days, all diarrheal fecal samples (regardless of tests requested) were sent to the European Coordinating Laboratory (ECL) for C. difficile toxin testing and culture. The CDI results and tests not requested at each submitting site were compared with the ECL results to determine the number of missed CDIs. Contemporaneous C. difficile isolates from food and animal sources were collected. All isolates underwent PCR ribotyping and toxinotyping; prevalences of ribotypes among regions of Europe and reservoir settings were compared. Results: Overall, 3,163 diarrheal fecal samples were received from 119 sites. The burden of CDI varied by country (positivity rates, 0–15.8%) and by European region; the highest positivity rate in Eastern Europe was 13.1%. The testing and positivity rates in community samples were 29.6% and 1.4% vs 74.9% and 5.0% in hospital samples; 16% and 55% of samples positive for CDI at ECL were not diagnosed in hospitals and the community. The most common C. difficile ribotypes from hospital samples were 027 (11%), 181 (12%), and 014 (8%), although prevalence varied by country. The highest prevalence of toxinotype IIIb (ribotypes 027, 181, and 176) was seen in Eastern Europe (55% of all isolates), which also had the lowest testing rate. For hospital samples, the proportion of toxinotype IIIb was inversely related to the testing rate (r = −0.79) (Fig. 1). The most common ribotypes from food sources were 078 (23%) and 126 (13%) (toxinotype V), and most common ribotypes from community samples were 078 (9%) and 039 (9%). Overall, 106 different ribotypes were identified: 25 in both the hospital and community and 16 in the hospital, community, and food chain. Conclusions: The diagnosed burden of CDI varies markedly among countries in both hospital and community settings. Reduced sampling/testing in Eastern Europe is inversely related to the proportion of toxinotype IIIb strains identified, suggesting that lack of suspicion leads to underdiagnosis and outbreaks of infection. The proportion of missed CDIs in the community was ~3.5× higher than in hospitals, indicating major underrecognition in the former setting. There were marked differences in ribotypes in different reservoir settings, emphasizing the complex epidemiology of C. difficile.Funding: Proprietary organization: COMBACTE-CDI is an EU funded (Horizon2020) consortium of academic and EFPIA partners (bioMerieux, GSK, Sanofi Pasteur, Astra Zeneca, Pfizer, Da Volterra) with additional Funding: from the EFPIA partners.Disclosures: Submitter: Kerrie Davies; the work presented is funded via the EU and EFPIA (commercial) partners in a consortium.

scholarly journals Characterization of Clostridium difficile isolates using capillary gel electrophoresis-based PCR ribotyping

2008 ◽  
Vol 57 (11) ◽  
pp. 1377-1382 ◽  
Author(s):  
A. Indra ◽  
S. Huhulescu ◽  
M. Schneeweis ◽  
P. Hasenberger ◽  
S. Kernbichler ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Gel Electrophoresis ◽  
Variable Number Tandem Repeat ◽  
Variable Number ◽  
Web Based ◽  
Healthcare Facilities ◽  
Capillary Gel Electrophoresis ◽  
Hands On ◽  
Pcr Ribotyping ◽  
Reference Strains

We have developed a Clostridium difficile PCR ribotyping method based on capillary gel electrophoresis and have compared it with conventional PCR ribotyping. A total of 146 C. difficile isolates were studied: five isolates were reference strains (PCR ribotypes 001, 014, 017, 027 and 053); 141 were clinical isolates comprising 39 Austrian PCR ribotypes collected in the period 2006–2007 at 25 Austrian healthcare facilities. Capillary gel electrophoresis yielded up to 11 fragments per isolate and 47 ribotype patterns. All but one of the five PCR ribotypes of reference strains were clearly reflected in the chromatograms of capillary-based typing. Capillary gel electrophoresis divided 24 isolates belonging to PCR ribotype type 014 into seven subgroups, whereas subtyping the same isolates using multiple-locus variable-number tandem-repeat analysis yielded three unrelated subgroups, without obvious correlation to sr subgroups. Using a web-based software program (http://webribo.ages.at), we were able to correctly identify these 014 isolates by simply allocating the seven subgroup patterns to one ribotype, i.e. to PCR ribotype 014. We consider capillary gel electrophoresis-based PCR ribotyping to be a way of overcoming the problems associated with inter-laboratory comparisons of typing results, while at the same time substantially diminishing the hands-on time for PCR ribotyping.

scholarly journals First Environmental Investigation of Toxigenic Clostridium difficile at a Large Hospital in Bangladesh

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S406-S406
Author(s):  
M Jahangir Alam ◽  
Khurshida Begum ◽  
Tasnuva Rashid ◽  
Irtiza Hasan ◽  
Jacob McPherson ◽  
...  
Keyword(s):  
Developing Countries ◽  
Clostridium Difficile ◽  
Enrichment Culture ◽  
Large Hospital ◽  
Environmental Investigation ◽  
Fluorescent Pcr ◽  
High Prevalence ◽  
Pcr Ribotyping ◽  
Developed World ◽  
Culture Positive

Abstract Background Toxigenic Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients in the developed world and an emerging pathogen in developing countries due to increased use of broad-spectrum antibiotics. Although likely ubiquitous worldwide, the prevalence of toxigenic C. difficile spores in the hospital environs of developing countries is poorly understood. The objectives of the study are to isolate and characterize C. difficile from the hospital environs of a large hospitals in Dhaka, Bangladesh. Methods As part of our environmental surveillance effort, we collected 330 shoe-bottom swab samples from hospital employees, patients, and visitors inside of a large hospital in Dhaka, Bangladesh. Samples were analyzed for C. difficile using anaerobic enrichment culture and molecular methods. Suspected colonies from cycloserine cefoxitin fructose agar (CCFA) plates were identified by PCR (tcdA, tcdB, cdtA, cdtB and tpi genes) and strain typed using fluorescent PCR ribotyping, and MLVA methods. Results A total 149 of 333 (44.7%) shoe-bottom swab samples were culture positive for C. difficile of which 19.8% samples were toxigenic (tcdA and tcdB) C. difficile. A total of 11 distinct ribotypes were identified from 58 toxigenic C. difficile isolates tested. Predominant ribotypes were F053-163 (24.1%), F017 (20.7%), F106 (19.0%), F014-020 (17.2%). Other ribotypes were R001, F005, F010, F018, F054, F216, and FP407. No R027 and R078 C. difficile isolated. A broad MLVA diversity has been seen among the tested strains. Conclusion We identified a high prevalence of toxigenic C. difficile with diverse ribotypes from hospital environmental shoe-bottom swabs in Bangladesh. This is the first hospital environmental report of C. difficile from Bangladesh. Disclosures All authors: No reported disclosures.

scholarly journals Cross-Sectional Study Reveals High Prevalence of Clostridium difficile Non-PCR Ribotype 078 Strains in Australian Veal Calves at Slaughter

2013 ◽  
Vol 79 (8) ◽  
pp. 2630-2635 ◽  
Author(s):  
Daniel R. Knight ◽  
Sara Thean ◽  
Papanin Putsathit ◽  
Stan Fenwick ◽  
Thomas V. Riley
Keyword(s):  
Clostridium Difficile ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Adult Cattle ◽  
Content Type ◽  
Retail Meats ◽  
High Prevalence ◽  
Pcr Ribotyping ◽  
Ribotype 078

ABSTRACTRecent reports in North America and Europe ofClostridium difficilebeing isolated from livestock and retail meats of bovine origin have raised concerns about the risk to public health. To assess the situation in Australia, we investigated the prevalence and genetic diversity ofC. difficilein adult cattle and calves at slaughter. Carcass washings, gastrointestinal contents, and feces were collected from abattoirs across five Australian states. Selective culture, toxin profiling, and PCR ribotyping were performed. The prevalence ofC. difficilewas 56% (203/360 samples) in feces from <7-day-old calves, 3.8% (1/26) in 2- to 6-month-old calves, and 1.8% (5/280) in adult cattle. Three PCR ribotypes (RTs), RT127, RT033, and RT126, predominated in <7-day-old calves and comprised 77.8% (158/203 samples) of isolates. RT056, which has not been reported in cattle before, was found in 16 <7-day-old calves (7.7%). Surprisingly, RT078 strains, which dominate production animal carriage studies in the Northern Hemisphere, were not isolated.

scholarly journals State-building for the market economy in Eastern Europe

2020 ◽  
Vol 70 (4) ◽  
pp. 471-491
Author(s):  
Paul Hare
Keyword(s):  
Eastern Europe ◽  
Rule Of Law ◽  
Law And Economics ◽  
Recent Analysis ◽  
The Rule Of Law ◽  
State Institutions ◽  
Role Of The State ◽  
New States ◽  
The Eu

AbstractKornai's earlier works embodied the idea that state institutions formed a system with a strong tendency to reproduce itself, and hence to resist minor reforms. Thus, at the end of socialism, huge changes were needed in politics, economics, and the law to build a new system oriented towards the market-type economy, which would again be stable, self-reinforcing and self-sustaining. Transition promoted the development of new states in Eastern Europe that conformed to the Copenhagen criteria for the EU accession. Were we too hasty in thinking that we had succeeded? The new systems are not returning to the previous one, and only in a few areas have the basic norms of a market-type economy been set aside in Hungary or Poland. But concerns arise at the interface between politics, law and economics – to do with the rule of law, the nature and role of the state, and the interactions between parliament, the executive and the judiciary. Unavoidably, there is also an interesting international dimension here, represented by the shift from the Warsaw Pact and CMEA to NATO and the EU. This paper explores these issues in the light of some of Kornai's recent analysis of developments in Hungary, while also drawing on his very insightful earlier works.

scholarly journals Prospects of Croatian initiative “The Baltic – Adriatic – Black Sea”

2017 ◽  
pp. 37-44 ◽  
Author(s):  
N. A. Samoylovskaya
Keyword(s):  
Eastern Europe ◽  
Central Europe ◽  
Black Sea ◽  
Regional Cooperation ◽  
Cultural Development ◽  
Southeast Europe ◽  
Geographical Position ◽  
The Baltic ◽  
The Impact ◽  
The Eu

In January 2015 K. Grabar-Kitarovic was elected as President of Croatia. She identified the integration of Southeast Europe countries into European and Euro-Atlantic institutions and strengthening the cooperation between the countries of Central Europe as a national strategic interest. In her opinion the 12 European member countries of the EU located between the Adriatic, Black and Baltic seas have great potential for regional cooperation in the framework of the EU and the transatlantic community. This potential depends on the geographical position and features of common economic and cultural development. In the presented work is described the evolution of the concept of “the Baltic-Adriatic-Black Sea” and the prospects of its promotion in the countries of Eastern Europe. Special attention is paid to the impact of the initiative on the economic and strategic interests of Russia in Eastern Europe.

scholarly journals Backwardness of Central and Eastern Europe as a Heritage of the Soviet Period

2020 ◽  
Vol 43 (338) ◽  
pp. 61-66
Author(s):  
Sandris Ancans
Keyword(s):  
Eastern Europe ◽  
Central And Eastern Europe ◽  
Communist Regime ◽  
European Region ◽  
Eastern European ◽  
Planned Economy ◽  
Command Economy ◽  
Centrally Planned Economy ◽  
Communist Countries ◽  
The Eu

AbstractThe economy of Latvia lags behind economically developed nations approximately fourfold in terms of labour productivity in the tradable sector, which is the key constituent of a modern economy, thereby affecting future sustainable development in the entire country, including the rural areas. The economic backwardness is characteristic of the entire Central and Eastern Europe. This is the heritage of a communist regime that lasted for about half a century and the economic system termed a (centrally) planned economy or a command economy. However, such a term for the communist-period economy is not correct, as it does not represent the purpose it was created for. Accordingly, the paper aims to assess the effect of the communism period on the economic backwardness of the Central and Eastern European region of the EU. A planned economy that existed in all communist countries, with the exception of Yugoslavia, was not introduced to contribute to prosperity. It was intended for confrontation or even warfare by the communist countries under the guidance of the USSR against other countries where no communism regime existed, mostly Western world nations with their market economies. For this reason, it is not correct to term it a (centrally) planned economy or a command economy; the right term is a mobilised (war) economy. An extrapolation of a geometric progression for GDP revealed that during the half a century, Latvia as part of the USSR was forced to spend on confrontation with the West not less than EUR 17 bln. (2011 prices) or approximately one gross domestic product of 2011. The research aim of the paper is to assess the effect of the communism period on the economic backwardness of the Central and Eastern European region of the EU.

scholarly journals Konceptualizácia a meranie variácií kapitalizmu v nových členských štátoch EÚ: Kritické zhodnotenie

2013 ◽  
Vol 15 (2–3) ◽  
pp. 136-148
Author(s):  
Pavol Baboš
Keyword(s):  
Eastern Europe ◽  
Future Research ◽  
Economic Institutions ◽  
Central Eastern Europe ◽  
Contemporary Research ◽  
Market Economic ◽  
Theoretical Reasoning ◽  
Successful Establishment ◽  
Contemporary Study ◽  
The Eu

Almost a decade has passed since the first post-communist states acceded to the EU. Ten years after confirmation of the successful establishment of democratic and market-economic institutions in these countries, it is time to ask what type of institutions really developed. This article critically reviews contemporary research into capitalism in the eight countries, the main approaches applied, and the findings published. Firstly, it attempts to identify the type of capitalism that has developed in the region. Secondly, it highlights some pitfalls in the contemporary study of capitalism in Central Eastern Europe and discusses possible remedies for future research. The main recommendation, discussed in more detail in the study, is that stricter theoretical reasoning would help to eliminate the contradictory conclusions many authors have arrived at.

scholarly journals Current application and future perspectives of molecular typing methods to study Clostridium difficile infections

2013 ◽  
Vol 18 (4) ◽  
Author(s):  
C W Knetsch ◽  
T D Lawley ◽  
M P Hensgens ◽  
J Corver ◽  
M W Wilcox ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Molecular Typing ◽  
Variable Number Tandem Repeat ◽  
Data Interpretation ◽  
Global Changes ◽  
Complex Data ◽  
Spatial And Temporal Patterns ◽  
Typing Method ◽  
Current Application ◽  
Pcr Ribotyping

Molecular typing is an essential tool to monitor Clostridium difficile infections and outbreaks within healthcare facilities. Molecular typing also plays a key role in defining the regional and global changes in circulating C. difficile types. The patterns of C. difficile types circulating within Europe (and globally) remain poorly understood, although international efforts are under way to understand the spatial and temporal patterns of C. difficile types. A complete picture is essential to properly investigate type-specific risk factors for C. difficile infections (CDI) and track long-range transmission. Currently, conventional agarose gel-based polymerase chain reaction (PCR) ribotyping is the most common typing method used in Europe to type C. difficile. Although this method has proved to be useful to study epidemiology on local, national and European level, efforts are made to replace it with capillary electrophoresis PCR ribotyping to increase pattern recognition, reproducibility and interpretation. However, this method lacks sufficient discriminatory power to study outbreaks and therefore multilocus variable-number tandem repeat analysis (MLVA) has been developed to study transmission between humans, animals and food. Sequence-based methods are increasingly being used for C. difficile fingerprinting/typing because of their ability to discriminate between highly related strains, the ease of data interpretation and transferability of data. The first studies using whole-genome single nucleotide polymorphism typing of healthcare-associated C. difficile within a clinically relevant timeframe are very promising and, although limited to select facilities because of complex data interpretation and high costs, these approaches will likely become commonly used over the coming years.

scholarly journals ‘The skies are empty and the continent is overflowing with insoluble problems’ – The Covid-19 crisis in the western Balkans and the failure of the EU

SEER ◽  
2021 ◽  
Vol 24 (1) ◽  
pp. 7-18
Author(s):  
Jens Becker ◽  
Ina Kulić
Keyword(s):  
Health Services ◽  
South Korea ◽  
Eastern Europe ◽  
Western Balkans ◽  
South Eastern ◽  
High Incidence ◽  
South Eastern Europe ◽  
Political Realities ◽  
The Eu

Many societies are still in the stranglehold of the coronavirus. China, South Korea and Taiwan have apparently overcome the pandemic but problems that are almost impossible to resolve are piling up in Europe. Despite the joint vaccination procurement campaign, the EU in particular is struggling to regulate the crisis domestically. The states of the western Balkans which have been relying on an EU perspective for years and which have repeatedly been put off, have also been hit hard, piling problems on top of health services that are, for a number of reasons, already seriously jeopardised. In view of the worsening situation - countries in central and south-eastern Europe are over-represented among those with the highest numbers of Covid-19 related deaths - we take a closer look at current practicalities and political realities in these ‘high incidence areas’, as the region is currently known (according to the Ost-Ausschuss der Deutschen Wirtschaft). This article focuses on the role of the EU, and how views of this are changing in the region, as well as that being played by other, apparently more nimble and agile, powers.

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