Clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other healthcare facilities. The elderly are particularly susceptible and at increased risk for adverse outcome as a result of C. difficile infection. The aim of this study was to determine the prevalence of C. difficile colonization among residents of nursing homes in Hesse and to compare it with the prevalence in the general population living outside long-term care facilities (LTCF). We assessed possible risk factors for C. difficile colonization and determined the genotype of circulating strains. C. difficile was isolated from 11/240 (4.6%) nursing home residents and 2/249 (0.8%) individuals living outside LTCF (p = 0.02). Ten of 11 (90.9%) isolates from nursing homes and one of two isolates from the population outside LTCF were toxigenic. The prevalence of C. difficile colonization varied from 0% to 10% between different nursing homes. Facilities with known actual or recent CDI cases were more likely to have colonized residents than facilities without known CDI cases. C. difficile PCR-ribotypes 014 and 001 were the most prevalent genotypes and accounted for 30% and 20% of toxigenic isolates in nursing homes, respectively. Interestingly, no individuals carried the epidemic strain PCR-ribotype 027. Our results suggest that residents of nursing homes in Germany are at high risk for colonization by virulent C. difficile strains. The high prevalence of C. difficile colonization in nursing homes underscores the importance of good adherence to standard infection control precautions even in the absence of a diagnosed infection. They also emphasize the need for specific programs to increase the awareness of healthcare professionals in LTCF for CDI.

w w w. e u ro s u rve i ll an c e . o rg 1 S u r v e i ll a n c e a n d o u t b r e a k r e p o r t s C l o s t r i d i u m d i f f i C i l e r i b o t y p e s 0 0 1 , 0 1 7 , a n d 0 2 7 a r e a s s o C i at e d w i t h l e t h a l C . d i f f i C i l e i n f e C t i o n i n h e s s e , G e r m a n y From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region.

Strategies for control and elimination of tuberculosis (TB) in low-incidence settings are directed toward treatment of recently acquired latent tuberculosis infection (LTBI) in TB contacts [1]. To identify this target population for preventive treatment the development of more specific, in vitro assays for LTBI, the interferon (INF)-c release assays (IGRAs), has offered an alternative method for LTBI diagnosis. Although IGRAs are increasingly recommended in national guidelines, evidence that positive IGRA results are prognostic for developing TB is still limited [2,3], especially outside of prospective studies with welldefined inclusion criteria. Therefore, we investigated progression towards active TB among IGRA positive contacts of active TB cases under routine field conditions and calculated the positive predictive value (PPV) for progression and the number needed to treat (NNT) with preventive treatment to prevent one incident TB case. Additionally, we introduced different cut-off values for IGRA positivity and compared the computed progression rates. Among all contacts with a positive tuberculosis-specific IGRA we describe the uptake of preventive treatment.Our study covered a population of 3.2 million with a reported TB incidence of 7.5 cases per 100 000 population in 2008. From 2008 to 2010, we prospectively recruited all IGRA-positive contacts of newly detected sputum smear and/or culture positive notified TB cases at 12 local public health authorities (LPHAs) in Hesse, Germany. Only contacts with a history of TB disease were excluded.

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We investigated a cluster of shiga toxin-producing Escherichia coli (STEC) O104:H4 infections after a family party during a large STEC O104:H4 outbreak in Germany. To identify the vehicle we conducted a retrospective cohort study. Stool samples of party guests, and food and environmental samples from the catering company were tested for STEC. We defined cases as party guests with gastrointestinal symptoms and laboratory-confirmed STEC infection. We found 23 cases among 71 guests. By multivariable analysis consumption of salmon [odds ratio (OR) 15, 95% confidence interval (CI) 2.3-97], herb cream (OR 6.5, 95% CI 1.3-33) and bean salad (OR 6.1, 95% CI 1.4-26) were associated with STEC infection. STEC O104:H4 was detected in samples of bell pepper and salmon. The food handler developed STEC infection. Our results point towards transmission via several food items contaminated by a food handler. We recommend regular education of food handlers emphasizing their role in transmitting infectious diseases.