Outbreak of Clostridium difficilePCR ribotype 027 - the recent experience of a regional hospital

Abstract

BackgroundClostridium difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, and several outbreaks with increased severity and mortality have been reported. In this study we report a C. difficile PCR ribotype 027 outbreak in Portugal, aiming to contribute to a better knowledge of the epidemiology of this agent in Europe.MethodsOutbreak report with retrospective study of medical records and active surveillance data of all inpatients with the diagnosis of CDI, from 1st January to 31th December 2012, in a Portuguese hospital. C. difficile isolates were characterized regarding ribotype, toxin genes and moxifloxin resistance. Outbreak control measures were taken, concerning communication, education, reinforcement of infection control measures, optimization of diagnosis and treatment of CDI, and antibiotic stewardship.ResultsFifty-three inpatients met the case definition of C. difficile-associated infection: 55% males, median age was 78.0 years (interquartile range: 71.0-86.0), 75% had co-morbidities, only 15% had a nonfatal condition, 68% had at least one criteria of severe disease at diagnosis, 89% received prior antibiotherapy, 79% of episodes were nosocomial. CDI rate peak was 13.89/10,000 bed days. Crude mortality rate at 6 months was 64.2% while CDI attributable cause was 11.3%. Worse outcome was related to older age (P = 0.022), severity criteria at diagnosis (leukocytosis (P = 0.008) and renal failure), and presence of fatal underlying condition (P = 0.025). PCR ribotype 027 was identified in 16 of 22 studied samples.ConclusionsThis is the first report of a 027-CDI outbreak in Portugal. We emphasize the relevance of the measures taken to control the outbreak and highlight the importance of implementing a close and active surveillance of CDI.

Clostridioides difficile ribotype distribution in a large teaching hospital in Serbia

“…Ribotype 027 infection caused severe form of CDI more often than other ribotypes, but it did not affect mortality and recurrence rates. (26). This study data also indicate higher mortality rate in patients with leukocytosis, renal failure and higher CRP.…”

Molecular and epidemiologic study of Clostridium difficile reveals unusual heterogeneity in clinical strains circulating in different regions in Portugal

“…In Portugal, some local studies showed an increasing incidence of CDI since 2007 but without providing any information concerning its causes. Recently, the first outbreak associated with RT027 was reported [10]. In addition, in the large CDI point prevalence study involving 482 hospitals from across 20 European countries, Portugal presented a considerably higher measured rate of CDI-positive samples compared to the reported rate [11].…”

Faecal microbiota transplant for recurrentClostridium difficileinfection using long-term frozen stool is effective: clinical efficacy and bacterial viability data

“…Clostridium difficile infection (CDI) is thought to result from a diminished indigenous colonic flora, particularly after the use of broad spectrum antibiotics, that allows C. difficile to proliferate into the resultant ecological void . Recurrent Clostridium difficile infection (rCDI) is an increasing problem and hypervirulent strains have emerged resulting in increased morbidity and mortality . Faecal microbiota transplant (FMT) has become the standard of care for patients with rCDI as a result of randomised control trial evidence of its superiority to traditional antibiotic therapy alone .…”