Clostridioides difficile infections (CDI) remain one of the more important gastro-intestinal infections in European hospitals, being responsible for 4.9% of all healthcare-associated infections. For this study, we present the latest trends on incidence of CDI in Belgium.

Data for period 2010-2022 was obtained through the national surveillance of CDI in Belgian acute hospitals. Hospitals voluntarily participating should report at least for one semester. Data are collected, validated, and reported through the secured environment of the Healthdata system.

Participation of eligible hospitals has decreased from 82% to 77% between 2010 and 2022, throughout this period the percentage of type and region of the participating hospitals remained comparable. In 2010, 62% of all reported CDI could be categorized ‘hospital-associated’ (HA-CDI), meaning symptoms occurring two days or more after admission. Twelve years later this accounts for 58% of all CDI. Over the study period, the reported CDI labelled as ‘recurrent’ remained around 10%. Between 2015 and 2021, a decrease of annual HA-CDI incidence was observed. In 2022, a significant increase in HA-CDI incidence was reported of 1.31 (95%CI 1.23 – 1.39) to 1.62 (95%CI 1.53 – 1.71), and for all CDI this was from 2.41 (95%CI 2.30 – 2.51) to 2.78 (95%CI 2.66 – 2.89).

HA-CDI are still a burden on hospitals compared to twelve years ago, although recent literature suggest that the importance of community-associated CDI should not be ignored. The COVID-19 pandemic did not seem to increase the burden of CDI in Belgian hospitals, possibly through the focus on infection, prevention and control measures, change in care seeking behaviour and lower use of some antimicrobials. The 2022 increase in incidence might be related to a post-pandemic change in the behaviour mentioned above and should be analysed further.