Benzylpenicillin is regaining attention as a treatment option for susceptible S. aureus, including in severe invasive diseases such as blood stream infections. Timely and reliable susceptibility determination is essential to support its use in clinical practice. In this study, we assessed the EUCAST-recommended methodology of interpreting zone edges in a national multicenter trial. In total, nine microbiology laboratories in Austria participated. Each center received 10 isolates in blinded duplicates, all with inhibition zones of ≥ 26 mm. Three were blaZ-positive with sharp edges and seven were blaZ-negative with fuzzy edges. Benzylpenicillin susceptibility testing according to EUCAST guidelines using 1 unit discs was performed by two independent technicians in duplicate on two separate days. All plates were interpreted by two different assessors generating a total of 1440 data points. Overall, 85.5

In spring 2022, an increase in metallo-β-lactamase-producing Pseudomonas aeruginosa (MBL-Pa) infections was detected in a hospital in Upper Austria. To identify the source of infection and to stop further transmissions, an epidemiological outbreak investigation including whole-genome sequencing (WGS)-based typing was conducted. The final case definition included cases admitted to the hospital between 2020 and 2023 with an MBL-Pa in one of the three genomic clusters identified. In addition, the investigation was extended to include historical cases from 2017. Core genome multilocus sequence typing was performed to assess the genetic relatedness between the isolates. Fifty-four clinical P. aeruginosa isolates and eight P. aeruginosa isolates from the hospital environment were obtained. All but nine isolates grouped into one of three genomic clusters (ST235/blaVIM-1, ST111/blaVIM-2, or ST621/blaIMP-13), which were considered to be distinct, prolonged outbreaks involving 47 out of 52 cases. The most likely source of infection for cluster 1 (ST111/blaVIM-2) and cluster 2 (ST235/blaVIM-1) was sinks in the intensive care unit (ICU) washroom. Cluster 3 clone (ST621/blaIMP-13) could have originated in the urology ward in 2020 and then spread to the ICU years later. However, the nosocomial origin of this clone could not be proven. In March 2023, following the implementation of control measures (gowning, patient isolation, screening, and daily disinfection), no further MLB-Pa was detected, and the outbreaks were considered to be over. As ICUs play an important role in the transmission of P. aeruginosa, emphasis should be placed on genomic surveillance, infection prevention, and control in such wards. IMPORTANCE:The significance of our work lies in the successful resolution of three prolonged outbreaks of MBL-Pa infections in a hospital in Upper Austria. Through a comprehensive epidemiological investigation coupled with WGS-based typing of P. aeruginosa isolates, the study identified three distinct genomic clusters responsible for prolonged outbreaks involving 47 cases. The investigation pinpointed sinks in the ICU washroom as the likely source of infection for two of the clusters. The study demonstrates the effectiveness of control measures such as hand hygiene, gowning, patient isolation, screening, and disinfection in stopping further transmission and bringing the outbreaks to a close. This underscores the critical role of genomic surveillance and control measures, particularly in high-risk settings like ICUs, in reducing nosocomial transmission of MBL-Pa infections.

Acute care hospitals traditionally have a combination of mixed occupancy rooms, i.e. two or more patients sharing the same room with an en suite, and single rooms occupied by one patient with or without a lobby. This has been changing in recent years with a move towards single rooms for most if not all patients. Single rooms are currently prioritized for providing a protective environment for immunocompromised patients who are at particular risk of serious infection (protective isolation) or for the isolation of those patients with transmissible infections who pose a risk to other patients (source isolation).

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.

Background There are differences in infection prevention and control (IPC) policies to prevent transmission of highly resistant microorganisms (HRMO). The aim of this study is to give an overview of the IPC policy of six European hospitals and their HRMO prevalence, to compare the IPC policies of these hospitals with international guidelines, and to investigate the hospitals' adherence to their own IPC policy. Methods The participating hospitals were located in Salzburg (Austria), Vienna (Austria), Kayseri (Turkey), Piraeus (Greece), Rome (Italy) and Rotterdam (The Netherlands). Data were collected via an online survey. Questions were aimed at prevalence rates in the years 2014, 2015, 2016 of carbapenemase-producing Klebsiella pneumoniae (CPK), carbapenemase-producing Pseudomonas aeruginosa (CPPA), vancomycin-resistant Enterococcus faecium (VRE) and hospitals' IPC policies of 2017. Implemented IPC measures (i.e. with a self-reported adherence of > 90%) were counted (26 points maximal). Results The self-reported prevalence of CPK per year was low in the Austrian and Dutch hospitals and high in the Turkish and Greek hospitals. CPPA was highly prevalent in the Turkish hospital only, while the prevalence of VRE in four hospitals, except the Austrian hospitals which reported lower prevalence numbers, was more evenly distributed. The Dutch hospital had implemented the most IPC measures (n = 21), the Turkish and Greek hospitals the least (n = 14 and 7, respectively). Conclusion Hospitals with the highest self-reported prevalence of CPK and CPPA reported the least implemented IPC measures. Also, hospitals with a higher prevalence often reported a lower adherence to own IPC policy.

Pertussis is a vaccine-preventable disease, and its recent resurgence might be attributable to the emergence of strains that differ genetically from the vaccine strain. We describe a novel pertussis isolate-based surveillance system and a core genome multilocus sequence typing scheme to assess Bordetella pertussis genetic variability and investigate the increased incidence of pertussis in Austria. During 2018-2020, we obtained 123 B. pertussis isolates and typed them with the new scheme (2,983 targets and preliminary cluster threshold of <6 alleles). B. pertussis isolates in Austria differed genetically from the vaccine strain, both in their core genomes and in their vaccine antigen genes; 31.7% of the isolates were pertactin-deficient. We detected 8 clusters, 1 of them with pertactin-deficient isolates and possibly part of a local outbreak. National expansion of the isolate-based surveillance system is needed to implement pertussis-control strategies.

BACKGROUND:The importance of defining and establishing professional standards for Clinical Microbiology (CM) in Europe has long been highlighted, starting with the development of a European curriculum. The first European Curriculum in Medical Microbiology (MM) was adopted by the European Union of Medical Specialists (UEMS) council in 2017.OBJECTIVES:This paper assesses how training programmes in CM in Europe align with the European curriculum, just under 5 years after its introduction, and reviews what methods of assessment are in use to assess the CM trainees' progress during training programmes.SOURCES:Using an internet-based platform, a questionnaire was circulated to the full, associate and observer members of the UEMS MM section. Information collected related to the structure, content and delivery of CM training in the participating countries, as well as methods of assessment used to evaluate training progress.CONTENT:Twenty-one countries responded, from a total of 30 countries invited to participate. All had a structured CM training programme, with a curriculum, dedicated trainers and a record of training activities. Fifteen countries require trainees to pass an exit examination, and over 60% of countries participate in continuous workplace-based assessment. Of the participating countries, 57% meet the European Training Requirements recommendation that duration of specialist training is 60 months. Regarding core competencies, all trainees gain experience in laboratory skills and infection prevention and control, but the emphasis on clinical management and antimicrobial stewardship is more varied across countries.IMPLICATIONS:The UEMS MM curriculum has been largely adopted by 21 countries within less than 5 years of ratification, which speaks optimistically to a future of standardized quality training across Europe. The introduction of a pilot European Examination in Clinical Microbiology in 2021 is the start of a pan-European assessment of the success of the implementation of this curriculum and the first step in quality assurance for CM training in Europe.

Introduction In patients with inflammatory bowel disease (IBD), Clostridium difficile infection (CDI) is a risk factor for both morbidity and mortality. Currently, appropriate management is unclear. Guidance on best practice in the diagnosis and treatment of CDI in IBD patients is therefore needed. Methods A multidisciplinary group of clinicians involved in the treatment of patients with IBD and CDI developed 27 consensus statements. Respondents were asked to rate their agreement with each statement using a 4-point Likert scale. Amodified Delphi methodology was used to review responses of 442 physicians from different specialties (including infectious disease specialists [n = 104], microbiologists [n = 95], and gastroenterologists [n = 73]). A threshold of 75 % agreement was predefined as consensus. Results Consensus was achieved for 17 of the 27 statements. Unprompted recognition of risk factors for CDI was low. Intensification of immunosuppressive therapy in the absence of clinical improvement was controversial. Clear definitions of treatment failure of antibiotic therapy in CDI and recurrence of CDI in IBD are needed. Respondents require further clarity regarding the place of fecal microbiota transplantation in CDI patients with IBD. Differences were observed between the perceptions of microbiologists and gastroenterologists, as well as between countries. Conclusions Different perceptions both between specialties and geographical locations complicate the development of an internationally accepted algorithm for the diagnosis and treatment of CDI in patients with IBD. This study highlights the need for future studies in this area.

Scope: Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes. Methods: An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings. Questions addressed by the guideline and recommendations: This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions. (c) 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages.

Cytomegalovirus reactivation can be life threatening. However, little evidence on its incidence in solid cancers is available. Therefore our single center Cytomegalovirus polymerase chain reaction database with altogether 890 CMV positive blood serum samples of mainly hematological and oncological patients was retrospectively analyzed to examine the occurrence of Cytomegalovirus reactivation in patients with solid tumors, resulting in 107 patients tested positive for Cytomegalovirus reactivation. Seventeen patients with solid cancer and a positive CMV-PCR test were identified, of which eight patients had clinically relevant CMV disease and received prompt antiviral treatment. Five patients fully recovered, but despite prompt antiviral treatment three patients died. Among these three patients two had significant co-infections (in one case EBV and in the other case Aspergillus) indicating that that CMV reactivation was at least one factor contributing to sepsis. The patient with the EBV co-infection was treated in an adjuvant therapy setting for breast cancer and died due to Cytomegalovirus and Epstein-Barr virus associated pneumonia despite intensive therapy. The other two patients had progressive disease of an underlying pancreatic cancer at the time of CMV diagnosis. One patient died due to attendant uncontrollable Aspergillus pneumonia, the other patient most likely died independent from CMV disease because of massively progressive underlying disease.Cytomegalovirus reactivation and disease might be underestimated in routine clinical practice. In our retrospective analysis we show that approximately 50 % of our patients suffering from solid cancers with a positive Cytomegalovirus polymerase chain reaction also had clinically relevant Cytomegalovirus disease requiring antiviral therapy.

Die wachsende Bedrohung durch Methicillin-resistente Staphylococcus (S.)-aureus (MRSA)-Stämme spiegelt sich insbesondere in dem kontinuierlich steigenden Anteil der Methicillin-Resistenz bei den klinischen S.-aureus-Isolaten wider. Dieser liegt derzeit in Deutschland bei ca. 20 %, in Österreich knapp unter 10 %. Strategien aus Niedrigprävalenzländern zeigen, dass eine solche Entwicklung nicht zwangsläufig ist. In Skandinavien und den Niederlanden hat sich die MRSA-Rate durch ein rigoroses Eradikations- und Präventionsprogramm auf einem konstant sehr niedrigen Niveau (< 1–3 %) stabilisiert. Im Zentrum einer solchen Search-and-destroy-Strategie steht die frühestmögliche Identifikation von MRSA-Trägern durch systematische Screeningabstriche bei Krankenhausaufnahme. Da mit den kulturellen Techniken 2 bis 3 Tage bis zum Vorliegen des definitiven Befundes vergehen, wurden schnellere Nachweisverfahren auf Basis der Polymerasekettenreaktion oder einer Schnellkultivierung (sog. MRSA-Schnelltests) entwickelt. Mit den innovativen Testkonzepten und -formaten ist es inzwischen möglich, eine MRSA-Trägerschaft zuverlässig innerhalb weniger Stunden auszuschließen. Positivnachweise sind allerdings mit der Möglichkeit falsch positiver Ergebnisse behaftet und bedürfen weiterhin der kulturellen Bestätigung. Die bisherigen Erfahrungen lassen vermuten, dass ein Schnelltest in den Hochrisikokollektiven die Rate der nosokomialen MRSA-Übertragungen senken kann. Die Daten zur Kosteneffizienz sind für eine definitive Beurteilung noch nicht aussagekräftig genug und zudem teilweise widersprüchlich.

A prospective, noninterventional survey was conducted among Clostridium difficile positive patients identified in the time period of July until October 2012 in 18 hospitals distributed across all nine Austrian provinces. Participating hospitals were asked to send stool samples or isolates from ten successive patients with C.difficile infection to the National Clostridium difficile Reference Laboratory at the Austrian Agency for Health and Food Safety for PCR-ribotyping and in vitro susceptibility testing. A total of 171 eligible patients were identified, including 73 patients with toxin-positive stool specimens and 98 patients from which C. difficile isolates were provided. Of the 159 patients with known age, 127 (74.3%) were 65 years or older, the median age was 76 years (range: 9-97 years), and the male to female ratio 2.2. Among these patients, 73% had health care-associated and 20% community-acquired C. difficile infection (indeterminable 7%). The all-cause, 30-day mortality was 8.8% (15/171). Stool samples yielded 46 different PCR-ribotypes, of which ribotypes 027 (20%), 014 (15.8%), 053 (10.5%), 078 (5.3%), and 002 (4.7%) were the five most prevalent. Ribotype 027 was found only in the provinces Vienna, Burgenland, and Lower Austria. Severe outcome of C. difficile infection was found to be associated with ribotype 053 (prevalence ratio: 3.04; 95% CI: 1.24, 7.44), not with the so-called hypervirulent ribotypes 027 and 078. All 027 and 053 isolates exhibited in vitro resistance against moxifloxacin. Fluoroquinolone use in the health care setting must be considered as a factor favoring the spread of these fluoroquinolone resistant C. difficile clones.

Contaminated surfaces contribute to transmission of C. difficile in the healthcare setting. The aim of the investigation was to assess the effectiveness of an environmental disinfection protocol consisting of daily use of the oxygen-releasing sporocide Oxygenon® Liquid (Antiseptica) in preventing nosocomial CDI, compared to daily surface disinfection with a quaternary ammonium compound-based product plus the oxygen-releasing sporicide Perform® (Schulke+) for targeted sporicidal environmental disinfection. In a pre-post single group study with patients of two internal medicine wards (A and B) between February 2008 and May 2011, we compared the CDI rate between the pre- and post-intervention phase by calculating the post-pre phase CDI rate-difference and preventable fraction. In a pre-post parallel groups study from August 2009 until May 2011, the post-pre phase CDI rate-difference of the experimental group (internal medicine ward B) was compared with the post-pre CDI rate-difference of a control group (general surgery department) by calculating the between-group difference in the post-pre CDI rate-difference. In the pre-post single group study, among patients ≥ 70 year olds, the post-pre phase CDI rate reduction of 14.0/10,000 bed-days was significant, and preventable fraction of CDI was 60.2% (95%CI: 15.6%-82.8%). The results of the pre-post parallel groups study suggested a superiority of the new environmental disinfection protocol at borderline significance. The post-pre CDI rate-difference in the experimental group was greater than the post-pre rate-difference in the control group by 10.4/10,000 bed-days. Using a sporicide for daily surface decontamination may be superior to targeted sporicidal disinfection in preventing nosocomial transmission of C. difficile.

Florian Thalhammer*, Gunter Weiss**, Franz Allerberger, Petra Apfalter, Rainer Gattringer, Reinhold Glehr, Andrea Grisold, Markus Hell, Christoph Hogenauer, Oskar Janata, Robert Krause, Christian Madl, Markus Peck-Radosavljevic, Wolfgang Petritsch, Robert Sauermann, Herbert Tilg, Agnes Wechsler-Fordos und Christoph Wenisch Klinische Abteilung fur Infektionen und Tropenmedizin, Universitatskliniklinik fur Innere Medizin I, Medizinische Universitat Wien; Infektiologie, Immunologie, Rheumatologie, Pneumologie; Universitatsklinik fur Innere Medizin VI, Medizinische Universitat Innsbruck; Osterreichische Agentur fur Gesundheit und Ernahrungssicherheit (AGES), Wien; Institut fur Hygiene, Mikrobiologie und Tropenmedizin, Krankenhaus der Elisabethinen Linz; 5Niedergelassener Arzt fur Allgemeinmedizin, Hartberg; Institut fur Hygiene, Mikrobiologie und Umweltmedizin, Medizinische Universitat Graz; Zentrum fur Krankenhaushygiene und Infektionskontrolle der SALK, Universitatsklinikum der PMU, Salzburg; Klinische Abteilung fur Gastroenterologie und Hepatologie, Universitatsklinik fur Innere Medizin, Medizinische Universitat Graz; Krankenhaushygiene, Donauspital im SMZ Ost der Stadt Wien; Infektiologie, Universitatsklinik fur Innere Medizin (UKIM), Medizinische Universitat Graz; 4. Medizinische Abteilung mit Gastroenterologie und Hepatologie, Krankenanstalt Rudolfstiftung, Wien; Klinische Abteilung fur Gastroenterologie und Hepatologie, Universitatsklinik fur Innere Medizin III, Medizinische Universitat Wien; Klinische Abteilung fur Gastroenterologie und Hepatologie, Universitatsklinik fur Innere Medizin, Medizinische Universitat Graz; Abteilung Vertragspartner Medikamente, Hauptverband der osterreichischen Sozialversicherungstrager, Wien; Klinische Abteilung fur Gastroenterologie und Hepatologie, Universitatsklinik fur Innere Medizin II, Medizinische Universitat Innsbruck; Krankenhaushygiene, Krankenhaus Rudolfstiftung Wien; 4. Medizinische Abteilung mit Infektiologie, SMZ Sud – KFJ-Spital der Stadt Wien

Active anti-microbial effects of larch (Larix decidua Mill.) and pine (Pinus sylvestris L.) wood materials on Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecium, and Bacillus subtilis were tested. The agar-diffusion test, a method used in routine diagnostics, was implemented to detect anti-microbial effects of wooden discs and filter paper discs containing methanol extracts of different wood parts. The results showed that the bark of larch had an inhibitory effect on Staphylococcus aureus, and the heart wood of pine showed a significant anti-microbial effect on the gram-positive bacteria tested (Staphylococcus aureus, Enterococcus faecium, and Bacillus subtilis). These results were confirmed by using methanol-extracts. An antimicrobial activity against Pseudomonas aeruginosa was not found. Antibacterial effects of other parts of larch wood and of pine sapwood were also not found. The results of this study showed for the first time that certain parts of wood contain compounds that directly reduce microbial growth. These data are a further demonstration of the positive effects of specific wood species and could promote the usage of wood in hygienically sensitive areas.

Clostridium difficile is considered a leading cause of hospital-acquired diarrhea. To evaluate the prevalence of asymptomatic C difficile stool carriage among hospital staff, we tested stool samples from 112 volunteers for toxigenic C difficile. Usually, there is no significant risk for healthy adults in acquiring a C difficile infection (CDI) because their mature colonic bacterial flora will resist colonization with C difficile.1Reeves A.E. Theriot C.M. Bergin I.L. Huffnagle G.B. Schloss P.D. Young V.B. The interplay between microbiome dynamics and pathogen dynamics in a murine model of Clostridium difficile infection.Gut Microbes. 2011; 2: 145-158Crossref PubMed Scopus (187) Google Scholar CDI in humans is generally linked to procedures that alter the normal enteric flora (antibiotic treatment or antineoplastic chemotherapy). Several outbreaks via a contaminated hospital environment or the contaminated hands of hospital personnel have shown the risk of nosocomial acquistion of CDI.2McFarland L.V. Mulligan M.E. Kwok R.Y. Stamm W.E. Nosocomial Acquisition of Clostridium difficile infection.N Engl J Med. 1989; 320: 204-210Crossref PubMed Scopus (1141) Google Scholar We chose to study the prevalence of C difficile stool carriage in asymptomatic hospital staff in Austria to assess the risk of healthy hospital staff acquiring C difficile. Probands were restricted to persons without a history of diarrhea or antibiotic usage for 3 months among hospital staff prior to testing (Table 1). Stool samples (n = 112) were gained from April to July 2010 at a 1,200 bed tertiary care university hospital. The male to female ratio was 1:5.3 (Table 2). The study was approved by the local ethics committee. Microbiological diagnostics were performed by direct plating onto C difficile selective agar (cycloserine/cefoxitin agar; bioMérieux, Marcy l'Etoile, France) plus broth enrichment as described elsewhere.3Mac Faddin J.D. Media for isolation-cultivation-identification-maintenance of medical bacteria. Vol. 1. Williams & Wilkins, Baltimore [MD]1985Google ScholarTable 1Study group by affiliationAbsolute number% Of totalGastroenterology98.0Hematology and oncology1916.9Pediatrics2118.8General surgery1916.9Pediatric surgery108.9Vascular surgery119.8Medical school students1210.7Anaesthesiology76.3Intensive care unit10.9Physical therapy32.7Total112100 Open table in a new tab Table 2Study group by occupationStudy groupAge, yrSexAbsolute number% Of totalMedianRangeFemaleClerical staff21.83529-41100%Janitorial staff32.75351-56100%Physiotherapists32.73230-34100%Nurses7768.83921-5694%Medical school Students119.82422-2782%Physicians1614.34728-6244%Total1121003921-6286% Open table in a new tab One hundred twelve healthy and asymptomatic staff members from 9 departments and the medical school were screened for C difficile. All stool samples tested negative by primary inoculation of the selective plate. Enough material (≥1 g) to perform testing by broth enrichment technique was available for 45 of the 112 samples (40.2%). Broth enrichment technique yielded negative results for all stool samples tested. Also, 67 stool samples provided by administrative staff of a major Austrian groceries chain proved negative when tested (parallel to our study) using both methods (data not shown). In medical literature, it is widely supposed that C difficile stool carriage is frequently found in healthy adults, including hospital staff. Van Nood et al reported 13% of asymptomatic hospital staff (75% of these being physicians) in The Netherlands to show C difficile stool carriage.4van Nood E. van Dijk K. Hegeman Z. Speelman P. Visser C.E. Asymptomatic carriage of Clostridium difficile among HCWs: do we disregard the doctor?.Infect Control Hosp Epidemiol. 2009; 30: 924-925Crossref PubMed Scopus (12) Google Scholar Kato et al demonstrated that 4.3% of hospital personnel in Japan carried C difficile.5Kato H. Kita H. Karasawa T. Maegawa T. Koino Y. Takakuwa H. et al.Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis.J Med Microbiol. 2001; 50: 720-727Crossref PubMed Scopus (104) Google Scholar Our finding of absence of fecal carriage in Austrian hospital staff was surprising but in accordance with results reported by Carmeli et al, who showed absence of intestinal carriage of C difficile among 55 hospital staff in Israel.6Carmeli Y. Venkataraman L. DeGirolami P.C. Lichtenberg D.A. Karchmer A.W. Samore M.H. Stool colonization of healthcare workers with selected resistant bacteria.Infect Control Hosp Epidemiol. 1998; 19: 38-40Crossref PubMed Scopus (22) Google Scholar In addition, our study has the limitation of a relatively low sample size, but it guarantees an upper confidence bound of 2.6% for zero findings (95% confidence level). Because specimens from symptomatic patients—tested for C difficile at the same time by the same method (direct plating)—yielded toxigenic C difficile, we abnegate the occurrence of false-negative results.7Hell M. Permoser M. Chmelizek G. Kern J.M. Maass M. Huhulescu S. et al.Clostridium difficile infection: monoclonal or polyclonal genesis?.Infection. 2011; 39: 461-465Crossref PubMed Scopus (13) Google Scholar Similar discrepant findings have previously been reported for occurrence of C difficile in food (ground meat): whereas Rodriguez-Palacios et al in Canada found 20% of tested samples positive for C difficile,8Rodriguez-Palacios A. Staempfli H.R. Duffield T. Weese J.S. Clostridium difficile in retail ground meat, Canada.Emerg Infect Dis. 2007; 13: 485-487Crossref PubMed Scopus (222) Google Scholar Jöbstl et al reported a contamination rate of only 3% C difficile in ground meat in Austria.9Jöbstl M. Heuberger S. Indra A. Nepf R. Köfer J. Wagner M. Clostridium difficile in raw products of animal origin.Int J Food Microbiol. 2010; 138: 172-175Crossref PubMed Scopus (73) Google Scholar This different contamination rate of ground meat might be just one of many factors explaining the discrepant results concerning C difficile carriage in healthy adults from different countries. In Austria, C difficile is the most frequently diagnosed bacterial pathogen in patients with community-acquired gastroenteritis, accounting for 18.7% of positive results, second only to norovirus (36.0%).10Huhulescu S. Kiss R. Brettlecker M. Cerny R.J. Hess C. Wewalka G. et al.Etiology of acute gastroenteritis in three sentinel general practices, Austria 2007.Infection. 2009; 37: 103-108Crossref PubMed Scopus (63) Google Scholar Our finding of absence of fecal carriage in healthy hospital staff and in healthy administrative staff of a food trade company underlines the diagnostic relevance of a positive stool result in patients with acute community acquired gastroenteritis. It also indicates that there is only low risk for healthy hospital staff for acquiring C difficile. Our findings also emphasize the diagnostic relevance of C difficile detection in symptomatic health care workers with diarrhea. We would like to thank Professor Christian Datz for providing us with stool samples of the non-hospital-staff and also Dr. David Schein for his support in proofreading.