Clostridium difficile 027 infection in Central Italy

被引:17
作者
Di Bella, Stefano [1 ]
Paglia, Maria Grazia [1 ]
Johnson, Emma [2 ]
Petrosillo, Nicola [1 ]
机构
[1] Natl Inst Infect Dis L Spallanzani, I-00149 Rome, Italy
[2] Sheffield Teaching Hosp NHS Fdn Trust, No Gen Hosp, Dept Microbiol, Sheffield, S Yorkshire, England
关键词
Clostridium difficile; CDAD; NAP1; 027; Italy; ANTIBODY-RESPONSE; NORTH-AMERICA; TOXIN-A; EPIDEMIC; DISEASE; EMERGENCE; DIAGNOSIS; STRAIN; DIARRHEA; COLITIS;
D O I
10.1186/1471-2334-12-370
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: Clostridium difficile (CD) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. The upsurge in incidence of CD coincided with the emergence of a hypervirulent strain of CD characterized as 027. In 2010, 8 cases of CD 027 infections were identified in Italy. Since then, no further reports have been published. We describe 10 new cases of CD 027 infection occurring in Italy. Methods: Since December 2010, stool samples of patients with severe diarrhea and clinical suspicion of the presence of a hypervirulent strain, were tested for CD 027 by the Xpert C. difficile PCR assay (Cepheid, Sunnyvale, CA). Clinical, epidemiological and laboratory data were collected. Results: From December 2010 to April 2012, 24 faecal samples from 19 patients who fit the above criteria were submitted to our laboratory. Samples were collected from 7 different hospitals. Of these, 17 had a positive PCR for CD and 10 were the epidemic 027 strain (59%). All PCR positive samples had a positive EIA toxin A/B test. Nine of 10 patients were recently exposed to antimicrobials and were healthcare-associated, including 4 with a history of long term care facility (LTCF) admission; the remaining case was community-associated, namely the wife of a patient with hospital-acquired CD 027 infection. Five patients experienced at least one recurrence of CD associated diarrhea (CDAD) with a total of 12 relapsing episodes. Of these, two patients had 5 and 6 relapses respectively. We compared the 10 patients with 027 CDAD versus the 7 patients with non-027 CDAD. None of the 7 patients with non-027 CDAD had a recent history of LTCF admission and no subsequent relapses were observed (p = 0.04). Conclusions: Our study shows that CD 027 is emerging in healthcare facilities in Italy. Whilst nosocomial acquisition accounted for the majority of such cases, 4 patients had history of a recent stay in a LTCF. We highlight the substantial risks of this highly transmissible organism in such environments. Moreover, 50% of our patients with CDAD from the 027 strain had high relapse rates which may serve to further establish this strain within the Italian health and social care systems.
引用
收藏
页数:6
相关论文
共 34 条
[1]   Excess hospitalisation burden associated with Clostridium difficile in patients with inflammatory bowel disease [J].
Ananthakrishnan, A. N. ;
McGinley, E. L. ;
Binion, D. G. .
GUT, 2008, 57 (02) :205-210
[2]   Treatment of Clostridium difficile-associated disease:: old therapies and new strategies [J].
Aslam, S ;
Hamill, R ;
Musher, DM .
LANCET INFECTIOUS DISEASES, 2005, 5 (09) :549-557
[3]   Evaluation of the Cepheid Xpert Clostridium difficile Epi Assay for Diagnosis of Clostridium difficile Infection and Typing of the NAP1 Strain at a Cancer Hospital [J].
Babady, N. Esther ;
Stiles, Jeffrey ;
Ruggiero, Phyllis ;
Khosa, Perminder ;
Huang, David ;
Shuptar, Susan ;
Kamboj, Mini ;
Kiehn, Timothy E. .
JOURNAL OF CLINICAL MICROBIOLOGY, 2010, 48 (12) :4519-4524
[4]   First Report of Hypervirulent Strains Polymerase Chain Reaction Ribotypes 027 and 078 Causing Severe Clostridium difficile Infection in Italy [J].
Baldan, Rossella ;
Cavallerio, Paolo ;
Tuscano, Antonella ;
Parlato, Caterina ;
Fossati, Lucina ;
Moro, Matteo ;
Serra, Roberto ;
Cirillo, Daniela M. .
CLINICAL INFECTIOUS DISEASES, 2010, 50 (01) :126-127
[5]   Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates [J].
Barbut, F. ;
Mastrantonio, P. ;
Delmee, M. ;
Brazier, J. ;
Kuijper, E. ;
Poxton, I. .
CLINICAL MICROBIOLOGY AND INFECTION, 2007, 13 (11) :1048-1057
[6]   Clinical recognition and diagnosis of Clostridium difficile infection [J].
Bartlett, John G. ;
Gerding, Dale N. .
CLINICAL INFECTIOUS DISEASES, 2008, 46 :S12-S18
[7]   European Society of Clinical Microbiology and Infectious Diseases (ESCMID): treatment guidance document for Clostridium difficile infection (CDI) [J].
Bauer, M. P. ;
Kuijper, E. J. ;
van Dissel, J. T. .
CLINICAL MICROBIOLOGY AND INFECTION, 2009, 15 (12) :1067-1079
[8]   Clostridium difficile infection in Europe: a hospital-based survey [J].
Bauer, Martijn P. ;
Notermans, Daan W. ;
van Benthem, Birgit H. B. ;
Brazier, Jon S. ;
Wilcox, Mark H. ;
Rupnik, Maja ;
Monnet, Dominique L. ;
van Dissel, Jaap T. ;
Kuijper, Ed J. .
LANCET, 2011, 377 (9759) :63-73
[9]   Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) [J].
Cohen, Stuart H. ;
Gerding, Dale N. ;
Johnson, Stuart ;
Kelly, Ciaran P. ;
Loo, Vivian G. ;
McDonald, L. Clifford ;
Pepin, Jacques ;
Wilcox, Mark H. .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2010, 31 (05) :431-455
[10]  
GOORHUIS A, 2007, CLIN INFECT DIS, V45, P695, DOI DOI 10.1086/520984