Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors

Sundram, F. X.; Guyot, Andrea; Carboo, I.; Green, S.; Lilaonitkul, M.; Scourfield, Andrew

doi:10.1016/j.jhin.2009.02.020

Cited by 57 publications

(41 citation statements)

References 14 publications

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“…Pepin et al found that longduration fluoroquinolone therapy enhanced the risk of CDI (154). A recent case-control study also reported that ciprofloxacin usage for Ͼ7 days was a significant risk factor for CDI (adjusted OR, 3.72; 95% CI, 1.38 to 10.02; P ϭ 0.019) (186). The restricted use of certain high-risk antimicrobials is a commonly used strategy for reducing CDI rates.…”

Section: Antibiotic Risk Factor and Prescribing Intervention Studiesmentioning

confidence: 99%

“…Infection with ribotype 027 was associated with an OR of 1.9 (P ϭ 0.041) for CDI-related death. In England, crude (death within 28 days) and early (death within 72 h) mortality rates were 23% and 11%, respectively, for CDI ribotype 027 cases, in comparison with 11% and 3%, respectively, for ribotype 106 cases (186). In Leeds, United Kingdom, 35 CDI cases caused by ribotype 027 were compared with 35 non-ribotype 027, age-, sex-, and location-matched cases (60).…”

Section: Evidence For Changing Clinical Virulence and Outcome Of CDImentioning

confidence: 99%

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The Changing Epidemiology of Clostridium difficile Infections

et al. 2010

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SUMMARY The epidemiology of Clostridium difficile infection (CDI) has changed dramatically during this millennium. Infection rates have increased markedly in most countries with detailed surveillance data. There have been clear changes in the clinical presentation, response to treatment, and outcome of CDI. These changes have been driven to a major degree by the emergence and epidemic spread of a novel strain, known as PCR ribotype 027 (sometimes referred to as BI/NAP1/027). We review the evidence for the changing epidemiology, clinical virulence and outcome of treatment of CDI, and the similarities and differences between data from various countries and continents. Community-acquired CDI has also emerged, although the evidence for this as a distinct new entity is less clear. There are new data on the etiology of and potential risk factors for CDI; controversial issues include specific antimicrobial agents, gastric acid suppressants, potential animal and food sources of C. difficile, and the effect of the use of alcohol-based hand hygiene agents.

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Section: Antibiotic Risk Factor and Prescribing Intervention Studiesmentioning

confidence: 99%

Section: Evidence For Changing Clinical Virulence and Outcome Of CDImentioning

confidence: 99%

The Changing Epidemiology of Clostridium difficile Infections

et al. 2010

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“…The results of the three typing methods (PCR ribotype, PFGE type, and REA group) were combined to give a composite strain type for five well-characterized strains previously identified in the literature in an effort to better understand their geographic distribution. This included the J strain (001/NAP2/J) (19,47), the toxin A-negative toxin B-positive ribotype 017 strain (017/NAP9/CF) (38), the hypervirulent/epidemic 027/NAP1/BI strain (33), the PCR ribotype 078 animal strain (078/NAP7/BK) (13,17,39), and the PCR ribotype 106 United Kingdom outbreak strain (106/ NAP11/DH) ( Table 5) (41). The 027/NAP1/BI strain was the most widely disseminated of the five strain types among the study sites and represented an overall mean of 25% of isolates recovered at each site (range, 11 to 54%) (data not shown).…”

Section: Bacterial Isolatesmentioning

confidence: 99%

“…The goals of this study were the following: (i) to compare the results of three C. difficile strain typing methods, i.e., PCRribotyping, REA, and PFGE, performed on toxigenic isolates available in pure culture, to determine how frequently the results were in agreement for the identification of common strains of C. difficile, such as the J strain (19), the toxin A-negative type 017 strain (38), the type 027/NAP1/BI hyperviruent/ epidemic strain (26,33), the type 078 "animal" strain (17,39), and the type 106 United Kingdom epidemic strain (41); (ii) to determine the frequency of isolation of these strains at various study sites in the United States and Canada; and (iii) to assess the accuracy of the Xpert C. difficile assay for identifying 027/ NAP1/BI strains directly in stool samples versus the strain types determined by the three typing methods on isolates obtained in pure culture.…”

mentioning

confidence: 99%

Comparison of Strain Typing Results for Clostridium difficile Isolates from North America

Tenover¹,

Åkerlund

Gerding

et al. 2011

J Clin Microbiol

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Accurate strain typing is critical for understanding the changing epidemiology of Clostridium difficile infections. We typed 350 isolates of toxigenic C. difficile from 2008 to 2009 from seven laboratories in the United States and Canada. Typing was performed by PCR-ribotyping, pulsed-field gel electrophoresis (PFGE), and restriction endonuclease analysis (REA) of whole-cell DNA. The Cepheid Xpert C. difficile test for presumptive identification of 027/NAP1/BI isolates was also tested directly on original stool samples. Of 350 isolates, 244 (70%) were known PCR ribotypes, 224 (68%) were 1 of 8 common REA groups, and 187 (54%) were known PFGE types. Eighty-four isolates typed as 027, NAP1, and BI, and 83 of these were identified as presumptive 027/NAP1/BI by Xpert C. difficile. Eight additional isolates were called presumptive 027/NAP1/BI by Xpert C. difficile, of which three were ribotype 027. Five PCR ribotypes contained multiple REA groups, and three North American pulsed-field (NAP) profiles contained both multiple REA groups and PCR ribotypes. There was modest concordance of results among the three methods for C. difficile strains, including the J strain (ribotype 001 and PFGE NAP2), the toxin A-negative 017 strain (PFGE NAP9 and REA type CF), the 078 animal strain (PFGE NAP7 and REA type BK), and type 106 (PFGE NAP11 and REA type DH). PCR-ribotyping, REA, and PFGE provide different but overlapping patterns of strain clustering. Unlike the other methods, the Xpert C. difficile 027/NAP1/BI assay gave results directly from stool specimens, required only 45 min to complete, but was limited to detection of a single strain type.

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“…Fluoroquinolones are antibiotics that are not recommended for use within primary care, except for a few specific infections, and their inappropriate use has been associated with an increased risk of CDI, particularly the 027 and 106 strains, both of which are prevalent in Scotland [13,15,33]. Excess usage of fluoroquinolones during the winter months suggests inappropriate use for respiratory infections.…”

Section: Primary Care Indicatorsmentioning

confidence: 99%