Environmental transmission of <i>Clostridioides difficile</i> ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

Endres, Bradley T.; Dotson, Kierra M; Poblete, Kelley; McPherson, Jacob; Lancaster, Chris; Bassères, Eugénie; Memariani, Ali; Arnold, Sandi; Tupy, Shawn; Carlsen, Conner; Morehead, Bonnie; Anyatonwu, Sophia; Cook, Christa; Begum, Khurshida; Alam, Mohammad Jahangir; Garey, Kevin W.

doi:10.1017/ice.2018.230

Cited by 18 publications

(7 citation statements)

References 23 publications

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“…The network is used to prospectively track outbreaks and identify the emergence of new strains. Our surveillance system provides up-to-date reporting to participating institutions, and identified one such outbreak due to a clonal strain in a long-term care facility [21]. Here we describe the changes in C. difficile ribotypes obtained from patient samples over the past seven years.…”

Section: Introductionmentioning

confidence: 99%

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Gonzales-Luna

Carlson

Dotson

et al. 2020

Emerging Microbes & Infections

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Clostridioides difficile infection (CDI) is the most prevalent healthcare-associated infection in the United States and carries a significant healthcare system burden. As part of an ongoing, active surveillance system of C. difficile throughout Texas, the objective of this study was to assess changes in C. difficile ribotypes of clinical isolates obtained from hospitalized patients in Texas over the past seven years. Fifty hospitals located in Texas, USA sent C. difficile positive stool specimens to a centralized laboratory for PCR ribotyping and toxin characterization between 2011 and 2018. Data collected included specimen collection date, patient age, and sex. Strain genotypes were compiled, and changes in ribotype distribution over time were assessed. Overall, 7796 samples were ribotyped from predominately female patients (58.4%) aged 62 ± 19 years. Samples were obtained from all geographic regions of Texas including Houston/Southwest region (n = 5129; 85%), Dallas/North Texas (n = 579, 9.6%), Central Texas (n = 164; 2.7%), and South Texas (n = 162; 2.6%). The 10 most common ribotypes comprised 73% of all isolates tested during the study period. The most common ribotypes were 027 (17.5%), followed by 014-020 (16.1%), 106 (11.6%), and 002 (9.1%). The prevalence of ribotypes 027, 001, and 078-126 declined significantly over time, while ribotypes 106 and 054 increased in prevalence (P < 0.001). Furthermore, the emergence of a novel ribotype 255 strain was observed. Differences in ribotype distribution were also noted based on age and geographic distribution (P < 0.001, each). This seven-year study demonstrated changing molecular epidemiology of C. difficile in Texas, including the emergence of a novel ribotype 255.

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Section: Introductionmentioning

confidence: 99%

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Gonzales-Luna

Carlson

Dotson

et al. 2020

Emerging Microbes & Infections

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“…Recent comparisons using WGS data analyzed by core genome MLST (cgMLST) or single nucleotide polymorphisms (SNP)-based methods have shown significant improvements over older technologies (46, 47). The advantages of using WGS for high-resolution typing has been seen in several pathogens, being particularly helpful in settings with (i) highly similar isolates over a long time period e.g., Legionella pneumophila within a city (48) or C. difficile (49, 50), (ii) a low endemic epidemiological background, but multiple clusters of patients from high endemic region with potential transmission events e.g., C. diphtheriae (31) or M. tuberculosis (51), and (iii) high endemic burden, where transmission events cannot easily be separated based on classical epidemiological information alone.…”

Section: Introductionmentioning

confidence: 99%

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Seth-Smith

Egli

2019

Front. Public Health

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Corynebacterium diphtheriae ( C. diphtheriae ) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis . Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.

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“…difficile infections (CDI) are often the consequence of untimely antibiotic use, particularly in the elderly who are on fluoroquinolones and proton pump inhibitors [152][153][154]. The elderly are a recognized risk group for CDI and outbreaks of CDI in institutions for the elderly are well known [155][156][157][158][159][160][161][162].…”

Section: What Metrics Should Be Used As Indicators Of Gastrointestina...mentioning

confidence: 99%

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

Bouza

Navarro²,

Alonso³

et al. 2023

Rev Esp Quimioter

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A progressively increasing percentage of the elderly live during the last years of their lives in nursing homes. Although these institutions are intended to mimic life at home as much as possible, they have characteristics that make them quite similar to a “nosocomiun”, i.e. an establishment for the treatment of the sick. The very coexistence among the elderly, the fact of sharing caregivers and the very significant exposure to third parties, together with the frequent predisposing diseases to infection in this population, make infection frequent among residents and also easily transmissible. This leads us to ask what can be done to prevent infection in this environment and more specifically what is the state of the art of the matter in a Western European nation such as ours. The Board of Trustees of the Health Sciences Foundation has asked itself a series of questions on the subject of infection prevention in Nursing Homes, the structure of procedures, the legislation available, compliance with the measures indicated, the best indicators of the processes and therefore, the need to promote in Spain a document of recommendations to avoid infections in this poplation whose morbidity and mortality need not be highlighted. To this end, a multidisciplinary group of experts in different aspects of this problem has been convened and asked the proposed questions. The questions were discussed by the group as a whole and led to a series of conclusions agreed upon by the participants. The results of the meeting are reported below.

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Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

Cited by 18 publications

References 23 publications

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

PCR ribotypes of Clostridioides difficile across Texas from 2011 to 2018 including emergence of ribotype 255

Whole Genome Sequencing for Surveillance of Diphtheria in Low Incidence Settings

Infection control in long term care institutions for the elderly: A reflection document on the situation in Spain

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