Epidemiology of Clostridioides difficile infections, France, 2010 to 2017.

BackgroundClostridioides difficile is a leading cause of healthcare-associated diarrhoea in middle and high-income countries. Up to 2018, there has been no systematic, annual surveillance for C. difficile infections (CDI) in France.AimsTo provide an updated overview of the epidemiology of CDI in France between 2010 and 2017 based on five different data sources.MethodsThis is a descriptive study of retrospective surveillance and alerts data. Incidence of CDI cases was estimated through the CDI incidence survey (2016) and data from the French National Uniform Hospital Discharge Database (PMSI; 2010-16). Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). The national early warning response system for HAI (HAI-EWRS, 2012-17) and National Reference Laboratory data (2012-17) were used to follow the number of severe CDI cases and/or outbreaks.ResultsIn 2016, CDI incidence in acute care was 3.6 cases per 10,000 patient days (PD). There was a statistically significant increase in CDI incidence between 2010 and 2016 (+ 14% annually) and testing frequency was 47.4 per 10,000 PD. The number of CDI HAI-EWRS notifications decreased between 2015 and 2017 with only a few large outbreaks reported.ConclusionThe CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence.

[Accreditation of the screening for the rectal carriage of vanA and/or vanB Vancomycin-resistant enterococci by an accredited laboratory under the standard NF EN ISO/IEC 17025:2005]. / Accréditation du dépistage du portage rectal des entérocoques résistants aux glycopeptides vanA et/ou vanB par un laboratoire déjà accrédité en portée B selon la norme NF EN ISO/CEI 17025:2005.

The quality of the screening of vanA and/or vanB Vancomycin-resistant enterococcal (VRE) carriage by patients transferred from foreign countries plays a role in the management of risks linked to extensively drug resistant organisms (XDRO). Accreditation of the screening according to the NF EN ISO 15189 and NF EN ISO/IEC 17025 standards contributes to satisfy the level of quality. Our laboratory was already accredited according to the NF EN ISO/IEC 17025 standard. We used its quality management system and the type B widened flexible scope to identify the required criteria based on microbiology and infection control standards and those of Afnor and Cofrac, and to validate the screening procedure. Accreditation was obtained for use of the Type B scope, for culture-based detection and identification (codes BA1 and BA5), for determination of the minimal inhibitory concentrations of glycopeptides (code BA6), and for the detection of resistance genes to glycopeptides by polymerase chain reaction (code BA8). The maturity of our quality management system contributed to validate the screening procedures following the required criteria of the NF EN ISO/IEC 17025 standard.