Diverse Sources of <i>C. difficile</i> Infection Identified on Whole-Genome Sequencing

Eyre, David W; Cule, Madeleine; Wilson, Daniel J.; Griffiths, David; Vaughan, Alison; O’Connor, Lily; Clc., Ip; Golubchik, Tanya; Batty, Elizabeth M.; Finney, Jack W.; Wyllie, David; Didelot, Xavier; Piazza, Paolo; Bowden, Rory; Dingle, Kate E.; Harding, Rosalind M.; Crook, Derrick W.; Wilcox, Mark H.; Peto, Tim E. A.; Walker, A. Sarah

doi:10.1056/nejmoa1216064

Cited by 598 publications

(658 citation statements)

References 38 publications

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“…Recent epidemiological studies have also shown that in addition to CDI patients, asymptomatic carriers and unknown sources of C. difficile are important contributors to new CDI cases. [10][11][12]27 Patients can develop CDI through 3 different infection histories: they can be admitted with CDI (CO-CDI), be admitted as colonized patients and become diseased during the hospital stay, or become both colonized and diseased patients during the hospital stay. Preventing CDI for these different timelines likely requires different prevention strategies (eg, note.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Lanzas

Dubberke

2014

Infect. Control Hosp. Epidemiol.

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ObjectiveBoth asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions.MethodsWe developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission.ResultsIn our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%–50% and 10%–25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy.ConclusionsTesting for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

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Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Similarly, Curry et al 12 found that CDI cases were as frequently linked to transmission from asymptomatic as to symptomatic patients. Therefore, the contribution of symptomatic cases to transmission and new infection is likely to be lower than previously thought.…”

mentioning

confidence: 98%

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Lanzas

Dubberke

2014

Infect. Control Hosp. Epidemiol.

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“…Because of the difficulties with ribotyping, there has been a move towards sequencing and in silico MLST as a substitute (Dingle et al, 2011). The limited amount of whole genome sequencing-based epidemiological data currently available nearly all comes from Oxfordshire, UK (Didelot et al, 2012;Dingle et al, 2014;Dingle et al, 2011;Eyre et al, 2013), although there have been smaller scale studies performed elsewhere in the world.…”

Section: Accepted Manuscript 16mentioning

confidence: 99%

Clostridium difficile infection: Evolution, phylogeny and molecular epidemiology

Elliott

Androga

Knight

et al. 2017

Infection, Genetics and Evolution

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Over the recent decades, Clostridium difficile infection (CDI) has emerged as a global public health threat. Despite growing attention, C. difficile remains a poorly understood pathogen, however, the exquisite sensitivity offered by next generation sequencing (NGS) technology has enabled analysis of the genome of C. difficile, giving us access to massive genomic data on factors such as virulence, evolution, and genetic relatedness within C. difficile groups. NGS has also demonstrated excellence in investigations of outbreaks and disease transmission, in both small and large-scale applications. This review summarizes the molecular epidemiology, evolution, and phylogeny of C. difficile, one of the most important pathogens worldwide in the current antibiotic resistance era.

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“…Complicating the epidemiology, it is estimated that up to a third of new CDI cases are community onset; 26,27 only 35% of inpatient CDI were linked to other hospital cases when investigated with whole genome sequencing. 28 …”

Section: Clostridium Difficile Infectionmentioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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Diverse Sources of C. difficile Infection Identified on Whole-Genome Sequencing

Cited by 598 publications

References 38 publications

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Clostridium difficile infection: Evolution, phylogeny and molecular epidemiology

Healthcare‐acquired infections: prevention strategies

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