In 2025 Hungarian hospitals reported a total of 6,772 Clostridium difficile infections involving severe diarrhoea. This is almost the same as in recent years, when the number of infections detected and reported was always close to seven thousand.

This national figure could be known before as well, but now the National Centre for Public Health and Pharmacy (NCPHP) – following a government decree issued in May – is trying something it has not tried before: on Thursday evening it published data broken down by hospital on an easy-to-use interactive platform. The calculations are based on a system that has been in operation for several decades, in which hospitals report the infections they find to the NCPHP, which then produces statistics from them. Until now, however, the content of these could not be examined in detail. (We wrote in more detail about the long road to making the hospital infection data public in this article.)

According to estimates, tens of thousands of hospital-acquired infections occur in Hungarian hospitals every year, which can cause suffering and serious complications for patients, and can even be fatal. It is dramatic that they catch these infections in the very place where they went to be cured: in hospital. The number of cases will never be zero, but some of them are certainly preventable.

Over the past three months the NCPHP has developed a methodology for analysing the infection data, created a database broken down by hospital, and built an interactive platform on which anyone can look up the data that interests them. In the first round, several large datasets have become searchable: the database of outbreaks that have occurred in hospitals; the detailed data of a comprehensive study carried out in 2022; and data on Clostridium difficile, an infection that spreads mainly in hospitals and causes severe diarrhoea. Databases on the so-called multidrug-resistant pathogens, which are resistant to strong antibiotics, and on bloodstream infections will be published later.

In this article we have selected from the more important data – mainly for 2025 – and the clearly visible anomalies on the platform, which has been accessible since this morning. (We are also contacting the hospitals concerned and will write about them separately.)

The NCPHP’s experts agree that the outlying values, that is, the anomalies, are particularly worth paying attention to when browsing the data. These anomalies can mean both good and bad things: they may show that the institution concerned is doing something very well, or, on the contrary, something very badly. In both cases it is worth taking a closer look at what is happening, and then – as the NCPHP intends – work on improvement can begin.

For this reason these data may be genuinely useful for the institutions themselves: they can look up how they perform on the indicators compared with others, and can learn from each other or set themselves targets to reach. What is more, they see even more detailed data: the NCPHP has made the figures for their own departments available to them as well, so that they can find where the problem lies and intervene in a targeted way.

The risk of infection varies greatly between hospitals

The first hospital infection database to become available contains data on a diarrhoeal infection, Clostridium difficile (CDI). This is an infection caused by a spore-forming bacterium that multiplies in the large intestine; in milder cases it involves greenish-yellow diarrhoea and cramps, while in severe cases it can lead to dehydration, extensive pseudomembranous colitis, a shutdown of bowel function or an abnormal dilation of the large intestine, which is a life-threatening condition.

As with almost every infection, the sooner it is identified and treated, the better the chance of recovery. Weakened patients who have undergone a course of strong antibiotics are more susceptible to more severe illness. The spores that cause the infection reach the environment in faeces and can then typically enter another person’s body via contaminated hands, objects, equipment or surfaces. The contaminated hands of healthcare workers and inadequately cleaned everyday objects and toilet surfaces play a particularly important role in spread within hospitals.

Hungary does not compare well on this infection in a European context. A 2022 study by the European Centre for Disease Prevention and Control (ECDC) found that Hungary has the second-highest rate of Clostridium difficile infection relative to other hospital-acquired infections. Simply put, this indicates that this infection spreads more freely in wards here than in other countries.

As can be seen from the published database, there is enormous variation between hospitals in the number of CDI cases, ranging from zero to almost five hundred a year. But this says little, because institutions treat very different numbers of patients in very different conditions. A better indicator is, for example, when the occurrence of infections is calculated in proportion to the number of so-called patient days. On the NCPHP’s platform, however, there is an even more sensitive indicator, which takes into account not only patient volume but also the differences between patients, and on that basis establishes a number that essentially shows how great the risk of infection is in the hospital concerned (compared with the average). Its developers, the biostatisticians Tamás Ferenci and György Surján, named it the “risk-adjusted infection ratio” (it can be read about in detail here). No indicator is perfect, but the calculation model behind this one seeks to filter out as many distorting factors as possible.

On this basis, the biggest outlier compared with the average, among the large institutions providing the highest level of care, is the Dél-pesti Centrum Hospital in Budapest. A total of 288 cases were found there in 2025, and it is far above the average on every indicator, meaning that an exceptionally large number of CDI infections occurred in this institution. On the basis of the indicator mentioned above, the risk of infection here is more than twice the average. At the same time, a very large number of stool samples were also taken and analysed there, so this hospital is also actively searching for cases of infection.

The situation is also less favourable than average at the Honvéd Hospital in Budapest, while, for example, the Markusovszky Hospital in Vas County and the Clinical Centre of the University of Debrecen visibly performed well on CDI infections. The data are certainly influenced by a range of factors, however, and not only by hospital hygiene – these may include equipment, the shortage of staff, the frequency of stool sample tests, the condition of the patients admitted, overcrowding and the possibility of isolating patients.

Among the second-level institutions, typically large city hospitals, the figures show worrying anomalies at the Bajcsy-Zsilinszky Hospital in Budapest, the Flór Ferenc Hospital in Kistarcsa and the Jahn Ferenc Hospital, also in Budapest. (According to Direkt36’s earlier analyses, these hospitals have long been struggling to reduce infections.) This means that at these institutions the risk of infection is much higher than average. At the Bajcsy-Zsilinszky Hospital the indicator mentioned, the risk-adjusted infection ratio, is 2.7, and at Kistarcsa 2.6 – whereas the expected level would be to approach a value of 1. It is true that these institutions, as we will come back to later, also test more stool samples than average. According to the same indicator, the situation appears excellent at, for example, the Erzsébet Teaching Hospital in Sopron and the Kanizsai Dorottya Hospital in Nagykanizsa, where fewer than a dozen CDI cases were detected in a year – although they also took fewer stool samples than average.

The diarrhoeal infection is also present among the patients of the smaller, city hospitals (which the NCPHP designates as first-level institutions), but here too there are enormous differences between hospitals. Looking at the risk of infection, there are several-fold differences. The hospitals of Orosháza, Nagyatád and Gyöngyös reported more favourable data, while at the Toldy Ferenc Hospital in Cegléd, for example, the figures indicate a more serious situation.

How many samples are tested where matters a great deal

The data also allow the rate of stool sampling to be looked up, which has been roughly the same every year (3.8 per 1,000 so-called patient days). This indicator is interesting because CDI infection can generally be detected from a stool sample. It is therefore basically good if many samples are taken and tested. Hospitals that test more are more likely to find more CDI infections, while where this is neglected, patients’ diarrhoeal symptoms may be caused by CDI and yet the infection is not identified. There is enormous variation between hospitals in this: in some places the figure is above 10, while in others it is closer to 1 or does not even reach it.

This variation holds regardless of the type of institution. While, for example, among the smaller (so-called first-level) hospitals only 0.2 stool samples per 1,000 patient days were taken at the Bugát Pál Hospital in Gyöngyös in 2025, at the Szent Margit Hospital in Budapest the same figure was 8.5. The other first-level hospitals fall between these values. Many kinds of reason may lie behind the large differences, and not only negligence: the number of samples taken is influenced by several factors, from patients’ symptoms to the availability of laboratories.

The variation is similar among the second-level hospitals: an outstandingly large number of stool samples are tested at the Bajcsy-Zsilinszky Hospital in Budapest and at the Flór Ferenc Hospital in Kistarcsa, and it is precisely in these institutions that the incidence of Clostridium difficile infections is also strikingly high. At the same time, the rate of stool sampling is also high at the Uzsoki Street Hospital in Budapest, but the incidence rate is much lower in this institution. This may indicate that the Uzsoki Hospital is preventing the spread of CDI more effectively than average, which may mean not only better hygiene but even that the hospital’s infrastructural or staffing conditions are more favourable.

Among the large university hospitals and county central hospitals providing the highest level of care, the differences are just as large when looking at the stool samples (here too the figures are for 2025). Relatively few samples are tested at, for example, the Bács-Kiskun County Teaching Hospital, which at the same time also has the lowest risk of infection compared with the average – there may be a connection between the two. The other extreme points to something similar: at the Dél-pesti Centrum Hospital in the capital a very large number of stool samples are tested compared with the others (10.6 per 1,000 patient days in 2025), but the institution is also far above the average in the risk of CDI infection (on the basis of the relevant indicator).

More than a hundred outbreaks linked to hospital-acquired infections broke out last year

Because infections spread easily among the weakened patients in hospitals, an outbreak can even develop in a particular department or in the whole hospital. According to the NCPHP’s website, hospitals treat cases of illness as an outbreak if the same healthcare-associated infection is confirmed in two or more patients. The great majority of these outbreaks are caused by the so-called multidrug-resistant pathogens, which are resistant even to strong antibiotics, but hospital outbreaks caused by the CDI infection already mentioned are also common.

The NCPHP’s data show that the number of outbreaks caused by hospital-acquired infections quadrupled in five years. While in 2021 there were 24 outbreaks in Hungarian hospitals that were linked to healthcare, in 2025 there were already 103. Last year these outbreaks affected 595 patients. According to the NCPHP, the drastic increase is partly due to the fact that since April 2024 legislation has stipulated that asymptomatic infections must also be counted in outbreaks. In their view this change contributed to the rise in the number of reported outbreaks.

The NCPHP’s database also reveals which hospitals had the most healthcare-associated outbreaks, and which bacteria caused them. The university and large county central hospitals classified by the authority as third-level – that is, those providing a higher level of care and often treating more seriously ill patients – struggled the most with these outbreaks.

At Semmelweis University, for example, 21 outbreaks broke out last year because of hospital-acquired infections, and a large part of these, 16 outbreaks, were caused by multidrug-resistant pathogens. This is an outlying figure, since in most hospitals providing similar care to Semmelweis there were fewer than 8 outbreaks. The number of outbreaks began to rise steeply after 2023, so this too may have had something to do with the administrative changes.

Compared with the other county and teaching hospitals, the incidence of outbreaks was high at the Szabolcs-Szatmár-Bereg County Teaching Hospital, where outbreaks broke out on 10 occasions last year, and at the Dél-pesti Centrum Hospital, where they broke out on 8 occasions. At the Clinical Centre of the University of Pécs and at the Észak-pesti Centrum Hospital – Honvéd Hospital, by contrast, staff did not report epidemic spread on a single occasion.

Among the smaller city hospitals providing lower-level care, the Toldy Ferenc Hospital in Cegléd stood out. Multidrug-resistant pathogens caused outbreaks there on 4 occasions. As Direkt36 revealed in its earlier series of articles, the hospital in Cegléd has been struggling for years to reduce multidrug-resistant pathogens.

According to our calculations, this type of infection occurred most frequently there in 2022. The hospital’s management was already aware of the shortcomings years ago. They even produced a pessimistic report in which they complained mainly about the outdated infrastructure and the shortage of specialists, and acknowledged that reducing infections was a problem. “The number of infections caused by special multidrug-resistant pathogens is increasing year by year,” they wrote in the report, adding that the problem is aggravated by the fact that “the difficulties of isolation and the insufficient number of isolation wards are a cause for concern”. Yet one of the most important elements of preventing outbreaks is being able to isolate infectious patients from the other patients.

Among the smaller hospitals, the Szent Margit Hospital in Budapest also struggled with outbreaks. At Szent Margit an outbreak broke out three times last year, and all of them were caused by the bacterium Clostridioides difficile. According to Direkt36’s earlier calculations, this was the hospital where the infection causing severe diarrhoea occurred most frequently in every year between 2020 and 2022. In addition to isolating patients, thorough hand disinfection is also important for stopping infections. An earlier Direkt36 article showed, however, that the Szent Margit Hospital does not use up the 20 litres of hand sanitiser per 1,000 patient days recommended by the World Health Organization (WHO) (a full day of hospital care for an inpatient counts as one patient day). In the case of the Budapest hospital this figure was 13.6 litres in 2022.

What is spreading in hospitals?

Pathogens spreading in hospitals are typically ones that are not killed even by concentrated disinfectants and that easily resist strong antibiotics. They are known as multidrug-resistant bacteria, and by infecting elderly or immunocompromised people lying in hospital beds who are already struggling with illness, they can cause serious disease.

There is a wide range of them, from multidrug-resistant Acinetobacter baumannii (MACI), which can cause pneumonia, wound infections and urinary tract infections, to the bacterium MRSA, which can cause abscesses and wounds to fester and heal with difficulty. The latter is one of those pathogens which, multiplying in the body, can enter the bloodstream and cause even fatal blood poisoning (sepsis). Common pathogens also include Clostridium difficile, a spore-forming bacterium that causes foul-smelling, mucousy diarrhoea and even severe inflammation of the intestines, and against which alcohol-based hand sanitiser is not effective either.

Pathogens can be spread by droplet transmission, faeces, wound drainage, through medical equipment and, to a not insignificant extent, by the insufficiently disinfected hands of a doctor, a nurse or a visitor. Without proper hygiene, pathogens can linger on medical equipment, hospital toilets, door handles, shower curtains, bed linen, nurse call buttons – almost anywhere. Any invasive procedure, such as surgery, as well as a tube, catheter or cannula sticking out of a patient, poses a risk of infection. The longer a person spends in hospital, the more likely they are to become infected. And even to die as a result.

This is a problem not only in Hungary but in hospitals all over the world. More and more superbugs are appearing and spreading. The difference lies in what countries’ healthcare systems do about the problem: whether they tackle it and keep it under control, or resign themselves to the situation and sweep it under the carpet. Not only the billions spent on treatment are at stake, but lives too: according to a globally accepted estimate, if hospitals do it right, 20-30 percent of infections – and in certain cases as much as 50 percent – can be prevented.

Cover photo by Zsolt Szigetváry / MTI