Background

; Clostridium difficile infection (CDI) incidence and mortality increased in North America and

; Europe over the last decade. Emerging hypervirulent, fluoroquinolone-resistant strains might

; have contributed to this. We measured CDI-related mortality, incidence and number of

; diagnostic tests performed for the period 1998-2007, to assess the epidemiology of CDI in

; Belgium.

; Methods

; We selected available data from: (1) mortality registries from Brussels, Flanders and

; Wallonia regions, (1998-2007)-records with ICD-10 code for Clostridium difficile enterocolitis.

; (2) from the Belgian hospital discharges database (1999-2007)-records with ICD-9-CM code

; for intestinal CDI. (3) from the Belgian social security database (1998-2007)-the number of

; CDI-related tests billed-. We calculated rates for mortality, hospital discharges and tests

; performed. We standardized mortality and hospital discharge data by age, using Belgian

; 2000 midyear population and European Standard population for international comparisons.

; We compared hospital discharge and diagnostic tests rate ratios.

; Results

; CDI-related crude mortality rate increased steadily since 1998 (0.1/100,000 inhabitants) in

; Brussels and Flanders, to its peak in Brussels in 2004 (5.7/100,000 inhabitants) , and its

; peak in Flanders in 2005 (1.3/100,000 inhabitants), and decreased in 2006 and 2007.The

; oldest age-group (>=80years) was most affected. After standardization for age, rates appear

; similar for men and women. Age-standardized rates of hospital discharge with a diagnosis

; of CDI increased from 17.1 per 100,000 inhabitants in 1999, to 41.7 in 2007. Between 2000

; and 2007 hospital discharges with CDI diagnosis increased by 240%, whereas diagnostic

; tests performed in hospitals increased by 160%.Belgian standardized CDI-related mortality

; rates were lower than those from other European countries and the US.

; Conclusion

; Both CDI-related mortality and morbidity have dramatically increased in Belgium between

; 1998 and 2007, especially in Brussels region. Mortality, but not morbidity, seems to be

; decreasing in the last years studied.