Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe

Kuijper, Ed J.; Coignard, B.; Brazier, J S; Suetens, Carl; Drudy, Denise; Wiuff, Camilla; Pituch, Hanna; Reichert, P; Schneider, François; Widmer, Andreas F.; Olsen, Katharina E. P.; Allerberger, Franz; Notermans, Daan W.; Barbut, Frédéric; Delmée, Michel; Wilcox, Mark H.; Pearson, A.; Patel, Bhavika B.; Brown, D. J. F.; Frei, Reno; Åkerlund, Thomas; Poxton, Ian R.; Tüll, Peet

doi:10.2807/esm.12.06.00714-en

Cited by 222 publications

(210 citation statements)

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“…Of note is that 12% of the non-027 ribotype isolates were C. difficile ribotype 078, an emerging strain that was reported as having mechanisms for toxin hyperproduction similar to those of ribotype 027. 2 The assessment of comparative clinical severity between patients infected with C. difficile ribotype 027 and those infected with other ribotypes requires further investigation with a larger sample size to allow the construction of multivariate models, which should include other factors that may have influenced our findings, for example, age, morbidity on admission, and effects of ribotype 078 infection. Thus, a definitive conclusion in relation to this assessment was not possible, and these findings must therefore be interpreted with caution.…”

Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

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Objective.To report a large outbreak ofClostridium difficileinfection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.Design.Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.Interventions.Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.Results.A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction betweenC. difficileribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months;P= .003).Conclusion.These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

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Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

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“…Some C. difficile strains produce a third additional toxin, called C. difficile binary toxin (CDT), which can enhance the attachment of C. difficile to intestinal epithelial cells (Schwan et al, 2009). Since 2003, outbreaks of C. difficile infection (CDI) due to an emerging strain of PCR ribotype 027 possessing CDT and resistant to erythromycin and/or clindamycin and newer fluoroquinolones have been reported in North America and Europe (Loo et al, 2005;Kuijper et al, 2008;Clements et al, 2010). This strain has a point mutation in tcdC, a putative negative regulator of toxins A and B (Spigaglia & Mastrantonio, 2002;McDonald et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004–2006

Pituch

Obuch-Woszczatyński

Wultańska

et al. 2011

Journal of Medical Microbiology

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Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004Poland, -2006 This study analysed 330 Clostridium difficile strains isolated from patients with C. difficile infection who were hospitalized in two university hospitals (H1 and H2) in Warsaw, Poland, over the period [2004][2005][2006]. Strains were investigated for the presence of tcdA (A), tcdB (B) and binary toxin (CDT) genes, and antimicrobial susceptibility was determined against nine agents. Among the 330 C. difficile isolates, 150 (45.4 %) were classified as A + B + CDT " , 18 (5.5 %) as A + B + CDT + , 144 (43.6 %) as A " B + CDT " and 18 (5.5 %) as A " B " CDT " . The predominant PCR ribotype in hospitals H1 and H2 was type 017 and accounted for 48.3 and 40.0 %, respectively. Only one PCR ribotype 027 strain was found. The rates of resistance to erythromycin and clindamycin in hospitals H1 and H2 were 53.6 and 53.6 %, and 48.6 and 47.5 %, respectively, whereas resistance rates to the newer fluoroquinolones gatifloxacin and moxifloxacin were 38.5 and 38.5 % (H1) and 38.4 and 40.1 % (H2). Erythromycin resistance was frequently associated with resistance to clindamycin and newer fluoroquinolones in strains belonging to type 017. No metronidazole-and vancomycin-resistant isolates were found, although two C. difficile isolates had elevated MIC values of metronidazole (MIC range 1.0"1.5 mg l "1 ) and 15 strains revealed elevated MIC values for vancomycin (MIC range 1.5-2.0 mg l "1 ). In conclusion, an increase in non-027 CDT-producing C. difficile strains was observed in Poland, but C. difficile PCR ribotype 017 remains a major circulating type. INTRODUCTIONClostridium difficile is a major cause of antibioticassociated diarrhoea in hospitalized patients (Freeman et al., 2010). Toxigenic isolates usually produce two toxins: toxin A (A) and toxin B (B). A 2 B + strains do not produce detectable amounts of toxin A due to a deletion in the repeating sequence of the tcdA gene encoding the toxin (Kato et al., 1998). Some C. difficile strains produce a third additional toxin, called C. difficile binary toxin (CDT), which can enhance the attachment of C. difficile to intestinal epithelial cells (Schwan et al., 2009)

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“…This strain is characterized by fluoroquinolone resistance, binary toxin production, and a mutation of the tcdC gene that results in increased toxin production (12). Although vancomycin remains effective against C. difficile, its use creates the potential for the selection of resistant strains of clostridia and other species, such as vancomycin-resistant enterococci, and could facilitate the spread of resistance determinants within the hospital environment (13).…”

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confidence: 99%

Effect of broad- and narrow-spectrum antimicrobials on Clostridium difficile and microbial diversity in a model of the distal colon

Rea

Dobson

O'Sullivan

et al. 2010

Proc. Natl. Acad. Sci. U.S.A.

329

263

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Vancomycin, metronidazole, and the bacteriocin lacticin 3147 are active against a wide range of bacterial species, including Clostridium difficile. We demonstrate that, in a human distal colon model, the addition of each of the three antimicrobials resulted in a significant decrease in numbers of C. difficile. However, their therapeutic use in the gastrointestinal tract may be compromised by their broad spectrum of activity, which would be expected to significantly impact on other members of the human gut microbiota. We used highthroughput pyrosequencing to compare the effect of each antimicrobial on the composition of the microbiota. All three treatments resulted in a decrease in the proportion of sequences assigned to the phyla Firmicutes and Bacteroidetes, with a corresponding increase in those assigned to members of the Proteobacteria. One possible means of avoiding such "collateral damage" would involve the application of a narrow-spectrum antimicrobial with specific anti-C. difficile activity. We tested this hypothesis using thuricin CD, a narrowspectrum bacteriocin produced by Bacillus thuringiensis, which is active against C. difficile. The results demonstrated that this bacteriocin was equally effective at killing C. difficile in the distal colon model but had no significant impact on the composition of the microbiota. This offers the possibility of developing a targeted approach to eliminating C. difficile in the colon, without collateral damage.gut microbiota | pyrosequencing | bacteriocin | antibiotic | thuricin

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Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe

Cited by 222 publications

References 2 publications

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Characterization and antimicrobial susceptibility of Clostridium difficile strains isolated from adult patients with diarrhoea hospitalized in two university hospitals in Poland, 2004–2006

Effect of broad- and narrow-spectrum antimicrobials on Clostridium difficile and microbial diversity in a model of the distal colon

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