Clostridium difficile in discharged inpatients, Germany.

To the Editor: Using discharge diagnoses from US hospitals in 2000-2003, McDonald et al. recently documented a dramatic increase in the rate of Clostridium difficile-associated disease (CDAD) (1). During the same period, a new strain of C. difficile was identified; this strain appears more virulent, at least in part because it produces higher levels of toxin (2).

To our knowledge, this strain has not been identified in Germany. However, to address this emerging threat, we conducted a similar analysis of discharge data to compare findings from the United States with data from Germany. We therefore determined the absolute number of inpatient discharges from all hospitals in Germany with the number of discharge diagnoses of CDAD reported in the national Statistische Bundesamt for the years 2000-2004. We then calculated the incidence of CDAD as a discharge diagnosis for each year and stratified our results by age groups (Figure).

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Our results confirm the observations from the United States. The effect of C. difficile on illness of patients in hospitals in Germany has escalated dramatically. This is true especially for patients [greater than or equal to]60 years of age. This trend indicates the need for increased awareness of this pathogen and a concerted effort to control CDAD by reducing unnecessary antimicrobial drug use and implementing currently recommended infection control measures. It also highlights the need to develop more rapid and accurate diagnostic tools and more effective prevention and treatment strategies.

References

(1.) McDonald LC, Owings M, Jernigan DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006;12: 409-15.

(2.) Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366:1079-84.

Ralf-Peter Vonberg, * Frank Schwab, ([dagger]) and Petra Gastmeier *

* Medical School Hannover, Hannover, Germany; and ([dagger]) Charite--University Medicine Berlin, Berlin, Germany.

Address for correspondence: Ralf-Peter Vonberg, Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; email: [e-mail]