Clostridium difficile Outbreak Strain BI Is Highly Endemic in Chicago Area Hospitals

Abstract

Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.

Clostridium difficileInfection (CDI) Severity and Outcome among Patients Infected with the NAP1/BI/027 Strain in a Non-Epidemic Setting

“…The incidence of CDI caused by the NAP1 strain in our study is lower than the rate reported among 25 hospitals in the Chicago area in 2009 (61%). 15 Our study found older age and residence at a nursing home immediately prior to hospitalization as risk factors among patients diagnosed with CDI caused by the NAP1 strain. Older age has been reported as a risk factor for the development of CDI caused by the NAP1 strain in epidemic and nonepidemic settings.…”

“…1,2,[12][13][14][15] Our single-center, retrospective, case-control study conducted during a non-epidemic CDI time period observed a NAP1 incidence of 18% among all CDI stool specimens. The incidence of CDI caused by the NAP1 strain in our study is lower than the rate reported among 25 hospitals in the Chicago area in 2009 (61%).…”

Clostridium difficilebinary toxin CDT

“…In one affected hospital in Pittsburgh, 17 colectomies were performed for fulminant CDI in 2000 compared with an average of 2.7 per year over the previous decade 86 . By 2009, this strain was endemic throughout the US, accounting for 61% of all clinical isolates from 25 acute healthcare facilities in Chicago 87 . Shortly after the reports in the US a multi-hospital regional CDI outbreak occurred in Canada involving over 12 hospitals in the Montreal area between 2003 and 2004 2 .…”

Clostridium difficile in the Long-Term Care Facility: Prevention and Management

“…In 2009, the rate of C. difficile infection-related hospitals stays for adults 65 – 84 years and ≥ 85 years was 4- and 10-fold greater, respectively, than for adults 45 – 64 years (24). Hospitalized patients developing C. difficile infection are more likely to be discharged to a LTCF (25–27), yet we know relatively little about the burden of this disease among this vulnerable population.…”

“…In a study of the epidemiology of C. difficile in multiple hospitals in the Chicago area, Black et al . that 67% of patients with C. difficile infection discharged to LTCFs were infected with BI/NAP1/027 strains (27). Among hospitalized patients with C. difficile infection, Archbald-Pannone et al .…”