Highlighting clinical needs in Clostridium difficile infection: the views of European healthcare professionals at the front line.

BACKGROUND: Clostridium difficile infection (CDI) is the leading cause of infectious nosocomial diarrhoea in Europe. Despite increased focus, its incidence and severity are increasing in many European countries. AIM: We developed a series of consensus statements to identify unmet clinical needs in the recognition and management of CDI. METHODS: A consortium of European experts prepared a series of 29 statements representing their collective views on the diagnosis and management of CDI in Europe. The statements were grouped into the following six broad themes: diagnosis; definitions of severity; treatment failure, recurrence and its consequences; infection prevention and control interventions; education and antimicrobial stewardship; and National CDI clinical guidance and policy. These statements were reviewed using questionnaires by 1047 clinicians involved in managing CDI, who indicated their level of agreement with each statement. FINDINGS: Levels of agreement exceeded the 66% threshold for consensus for 27 out of 29 statements (93.1%), indicating strong support. Variance between countries and specialties was analysed and showed strong alignment with the overall consensus scores. CONCLUSION: Based on the consensus scores of the respondent group, recommendations are suggested for the further development of CDI services in order to reduce transmission and recurrence and to ensure that appropriate diagnosis and treatment strategies are applied across all healthcare settings.Astellas Pharma EMEA initiated and fully supported the\ud
consensus project including the selection of the initial faculty\ud
of experts, who were able to cover the broad aspects of\ud
CDI management. Astellas Pharma EMEA paid the expert\ud
group an honorarium and travel expenses. Astellas Pharma\ud
EMEA commissioned Triducive Ltd to facilitate the project\ud
and analyse the responses to the consensus statements, in\ud
line with the Delphi methodology, and supported the authors\ud
in producing the manuscript. Astellas Pharma EMEA\ud
provided editorial assistance for the final manuscript by way\ud
of a factual accuracy check only. H. Seifert reports grants or\ud
research support from the Bundesministerium fu¨r Bildung\ud
und Forschung (BMBF), Germany, the German Center for\ud
Infection Research, Basilea, Novartis and Pfizer; has been a\ud
consultant for Astellas, AstraZeneca, Basilea, Cubist,\ud
Novartis, Pfizer, and The Medicines Company; and has\ud
received payments for lectures from MSD, Novartis, and\ud
Pfizer. A. Stallmach reports honoraria for participating in\ud
scientific advisory boards organized by Astellas. All of his\ud
activities and contracts are in conformity with the ‘FSAKodex\ud
Fachkreise’ (voluntary self-monitoring code for\ud
expert consultants to the pharmaceutical industry), have\ud
been checked by the Medicolegal Department of the University\ud
Hospital Jena, and have been approved by the\ud
directorate of the Faculty of Medicine. S. Goldenberg reports\ud
consulting fees, lecture fees, and research grants from\ud
Astellas. V. Anttila reports research support from MSD,\ud
Pfizer, GSK, and Astellas, consulting fees from MSD, and\ud
lecture fees from MSD, Pfizer, and Astellas. D. Jenkins reports\ud
speaker fees and advisory board fees from Astellas and\ud
is a director of Healthcare Infection Prevention Ltd. T.\ud
Galperine reports advisory board fees from Astellas. N.\ud
Petrosillo reports speaker’s fees from MSD, Novartis, Astellas,\ud
Gilead, Pfizer, advisory board fees from Carefusion,\ud
Johnson & Johnson, Achaogen, and The Medicines Company.\ud
T. Nore´n reports advisory board fees from AstellasPeer-reviewedPublisher Versio