An outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study. Cases (n = 79), diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316). Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10) was genotyped by Whole Genome Sequencing (WGS). WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates). Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU) (OR: 2.4, 95% CI 1.0-5.6), longer length of stay (LOS), and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6). Analysis of patients who stayed at the ICU (35 cases; 51 controls), indicated that the use of selective decontamination of the digestive tract (SDD) and a longer LOS in the ICU were associated with CDI risk. In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.
An outbreak of Clostridium difficile ribotype 027 infection ( CDI ) occurred at an university hospital , involving 19 departments . To determine what hospital - associated factors drove the outbreak of this particular strain we performed a case - control study . Cases ( n = 79 ) , diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients ( n = 316 ) . Patients diagnosed with CDI due to other ribotypes were included as a second control group . A random selection of C. difficile ribotype 027 strains ( n = 10 ) was genotyped by Whole Genome Sequencing ( WGS ) . WGS showed the outbreak was likely caused by a single strain of C. difficile ( two or less single - nucleotide variants between isolates ) . Ninety - five percent of cases had used antibiotics , compared to 56 % of controls . Previous admission to the intensive care unit ( ICU ) ( OR : 2.4 , 95 % CI 1.0 - 5.6 ) , longer length of stay ( LOS ) , and recent hospital admission were associated with CDI ribotype 027 . Cases were less likely to have been admitted to a ward with a known isolated CDI patient ( OR : 0.2 , 95 % CI 0.1 - 0.6 ) . Analysis of patients who stayed at the ICU ( 35 cases ; 51 controls ) , indicated that the use of selective decontamination of the digestive tract ( SDD ) and a longer LOS in the ICU were associated with CDI risk . In this large outbreak , any antibiotic use , including SDD use , appeared as a prerequisite for acquisition of the outbreak strain . The role of use of SDD and prolonged stay on the ICU could not be disentangled , but both factors can play a biologically plausible role in C. difficile acquisition and infection .
Which main ribotype of Clostridium difficile is responsible of the recent outbreak?
Which main ribotype of Clostridium difficile is responsible of the recent outbreak ?
Ribotype 027
Ribotype 027