Infection with Clostridium difficile (CDI) bacteria is the leading cause of hospital-acquired diarrhea in industrialized nations, and recurrence of the infection occurs in up to 25 percent of patients age 65 or older. The fact that it recurs so often and can be deadly already makes it challenging to treat, but a new study gives European medical experts additional reason for concern.

Researchers found that 109 CDI infections were missed in a single day in European hospitals “due to a lack of clinical suspicion or inadequate laboratory testing,” according to a press release describing the research, which was presented at the 24th European Congress of Clinical Microbiology and Infectious Diseases. That could amount to more than 39,000 missed CDI cases in Europe annually.

CDI incidence in Europe is on the rise, increasing from 4.12 to 7.9 of 100,000 patient bed days between the years 2008 and 2012-2013, respectively, according to the release. Also, CDI PCR-ribotype 027, which is one of the “most virulent PCR-ribotypes associated with CDI epidemics,” was found to be the most common type in Europe, while countries that reported the highest CDI testing rates had the lowest rates of this strain.

“Countries with increased awareness of CDI have probably been able to reduce outbreaks associated with the most virulent C. difficile strains by improving the early diagnosis of this usually healthcare-associated infection,” said researcher Mark Wilcox, professor of medical microbiology at the United Kingdom-based Leeds Teaching Hospitals and University of Leeds, in a prepared statement. “This study highlights that it is essential that we improve the implementation of CDI testing in hospitals, in order to tackle the issue of the increasing incidence of CDI across Europe.”

In this study, participating hospitals submitted 7,181 fecal samples on two separate dates occurring in winter 2012-2013 and the summer of 2013. The study results “highlight marked recent shifts in CDI testing policy and methodology across Europe, resulting in improved testing policies and selection of laboratory methods,” the release states. False-positive rates decreased between the two collection dates in countries that developed improved testing methods and procedures.

“Despite this, more than 50 percent of hospitals are still not using the most accurate testing procedure for CDI, and more than one in five (21.8%) samples found to be positive for CDI at the [study’s national coordinating laboratories] had not been tested at the local hospital level,” according to the release. The research also showed that 52.1 percent of European hospitals only perform CDI testing if a doctor requests it.

“Guidelines recommend that hospitals test for CDI on all unformed stools when the cause of diarrhea is not clear,” Wilcox said. “However, we are still seeing an issue with both a lack of clinical suspicion and lack of testing for CDI.”

See the multimedia press release online.