Characterization of a
            <i>Clostridioides difficile</i>
            outbreak caused by PCR ribotype 046, associated with increased mortality

Magnusson, Cecilia; Mernelius, Sara; Bengnér, Malin; Norén, Torbjörn; Serrander, Lena; Forshell, Sophie; Matussek, Andreas

doi:10.1080/22221751.2022.2049981

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…6,7 Indirect transmission between patients can lead to outbreaks with severe consequences. 5,8 Although whole-genome sequencing (WGS) together with epidemiological data is the best way of identifying transmission, it is costly and unpractical to perform on all positive C. difficile specimens in clinical practice. Simple tools are needed to screen for CDI cases to suspect as part of transmission chains and further examined by molecular typing and/or WGS.…”

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confidence: 99%

“…3,4 National surveillance data have shown a high diversity of ribotypes, and only a few outbreaks have been described in recent years. 4,5 However, the incidence of transmission of C. difficile in Swedish hospitals in the absence of apparent outbreaks has hardly been studied. 6,7 Indirect transmission between patients can lead to outbreaks with severe consequences.…”

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confidence: 99%

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Clostridioides difficile outbreak detection: Evaluation by ribotyping and whole-genome sequencing of a surveillance algorithm based on ward-specific cutoffs

Edman-Wallér

Toepfer

Karp

et al. 2023

Infect. Control Hosp. Epidemiol.

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Objective: We evaluated the performance of an early-warning algorithm, based on ward-specific incidence cutoffs for detecting Clostridioides difficile transmission in hospitals. We also sought to determine the frequency of intrahospital Clostridioides difficile transmission in our setting. Design: Diagnostic performance of the algorithm was tested with confirmed transmission events as the comparison criterion. Transmission events were identified by a combination of high-molecular-weight typing, ward history, ribotyping, and whole-genome sequencing (WGS). Setting: The study was conducted in 2 major and 2 minor secondary-care hospitals with adjacent catchment areas in western Sweden, comprising a total population of ∼480,000 and ∼1,000 hospital beds. Patients: All patients with a positive PCR test for Clostridioides difficile toxin B during 2020 and 2021. Methods: We conducted culturing and high-molecular-weight typing of all positive clinical samples. Ward history was determined for each patient to find possible epidemiological links between patients with the same type. Transmission events were determined by PCR ribotyping followed by WGS. Results: We identified 4 clusters comprising a total of 10 patients (1.5%) among 673 positive samples that were able to be cultured and then typed by high-molecular-weight typing. The early-warning algorithm performed no better than chance; patient diagnoses were made at wards other than those where the transmission events likely occurred. Conclusions: In surveillance of potential transmission, it is insufficient to consider only the ward where diagnosis is made, especially in settings with high strain diversity. Transmission within wards occurs sporadically in our setting.

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confidence: 99%