Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections

Abstract

BackgroundHere we describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of C. difficile and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of CDI.MethodsEpidemiological analysis included typing of C. difficile strains and analysis of possible patient to patient transmission. Infection control measures comprised strict isolation of CDI patients, additional hand washings, and intensified environmental cleaning with sporicidal disinfection. In addition an antibiotic stewardship program was implemented in order to prevent the use of CDI high risk antimicrobials such as fluoroquinolones, clindamycin, and cephalosporins.ResultsThe majority of CDI (n = 15) were caused by C. difficile ribotype 027 (RT027). Most RT027 isolates (n = 9) showed high minimal inhibitory concentrations (MIC) for levofloxacin, clindamycin, and remarkably to rifampicin, which were all used for the treatment of osteoarticular infections. Epidemiological analysis, however, revealed no closer genetic relationship among the majority of RT027 isolates. The incidence of CDI was reduced only when a significant reduction in the use of fluoroquinolones (p = 0.006), third generation cephalosporins (p = 0.015), and clindamycin (p = 0.001) was achieved after implementation of an intensified antibiotic stewardship program which included a systematic review of all antibiotic prescriptions.ConclusionThe successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections.

Clostridioides difficile Ribotype 027 (RT027) Outbreak Investigation Due to the Emergence of Rifampicin Resistance Using Multilocus Variable-Number Tandem Repeat Analysis (MLVA)

“…33 In Germany strains of C. difficile belonging to RT 027 resistant to rifampicin were isolated among patients with osteoarticular infections who were frequently treated with rifampicin. 34 Nyc et al 35 conducted a CDI analysis in 10 academic hospitals in Slovakia by MLVA, testing RT 001 C. difficile fecal isolates of patients from 14 Departments. RT 001, occurred in the years 2007/9 in high percentages in various regions of Europe (Germany, Scotland, Croatia).…”

Molecular epidemiology and antimicrobial resistance of Clostridioides difficile detected in chicken, soil and human samples from Zimbabwe

“…To determine the epidemiological relationship among samples, all isolates displaying the same RT were subtyped using multiplelocus variable-number tandem repeat analysis (MLVA) as described before (Berger et al, 2019a;Färber et al, 2017). Clonality was defined as 2 repeat differences and relatedness as 10 differences (Berger et al, 2019a;Färber et al, 2017). Since the study focused in part on zoonotic transmission, whole genome sequencing (WGS) was applied on samples that clustered in MLVA and included human and non-human samples in the same cluster.…”