Use of Multilocus Variable Number of Tandem Repeats Analysis Genotyping to Determine the Role of Asymptomatic Carriers in Clostridium difficile Transmission

被引:175
作者
Curry, Scott R. [1 ,2 ]
Muto, Carlene A. [1 ,2 ,3 ]
Schlackman, Jessica L. [2 ]
Pasculle, A. William [4 ]
Shutt, Kathleen A. [1 ,2 ]
Marsh, Jane W. [1 ,2 ]
Harrison, Lee H. [1 ,2 ]
机构
[1] Univ Pittsburgh, Sch Med, Div Infect Dis, Dept Med, Pittsburgh, PA 15261 USA
[2] Univ Pittsburgh, Sch Med, Infect Dis Epidemiol Res Unit, Pittsburgh, PA 15261 USA
[3] Univ Pittsburgh, Med Ctr, Div Hosp Epidemiol & Infect Control, Pittsburgh, PA 15261 USA
[4] Univ Pittsburgh, Sch Med, Dept Pathol, Div Microbiol, Pittsburgh, PA 15261 USA
关键词
Clostridium difficile; screening; transmission; genotyping; MLVA; RESTRICTION-ENDONUCLEASE ANALYSIS; INFECTION; COLONIZATION; SURVEILLANCE; ACQUISITION; HOSPITALS; EPIDEMIC; DIARRHEA; STRAINS; DISEASE;
D O I
10.1093/cid/cit475
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Previous studies have suggested that asymptomatic carriers of toxigenic Clostridium difficile are a source of hospital-associated (HA) infections. Multilocus variable number of tandem repeats analysis (MLVA) is a highly discriminatory molecular subtyping tool that helps to determine possible transmission sources. Methods. Clostridium difficile isolates were recovered from perirectal swabs collected for vancomycin-resistant Enterococcus (VRE) surveillance as well as from clinical C. difficile toxin-positive stool samples from July to November 2009 at the University of Pittsburgh Medical Center Presbyterian (UPMC). MLVA was performed to determine the genetic relationships between isolates from asymptomatic carriers and patients with HA C. difficile infection (HA-CDI). Asymptomatic carriage and HA-CDI isolates were considered to be associated if the carriage isolate was collected before the HA-CDI isolate and if the MLVA genotypes had a summed tandem-repeat difference of <= 2. Results. Of 3006 patients screened, 314 (10.4%) were positive for toxigenic C. difficile, of whom 226 (7.5%) were detected only by VRE surveillance cultures. Of 56 incident cases of CDI classified as HA at UPMC during the study with available isolates, 17 (30%) cases were associated with CDI patients, whereas 16 (29%) cases were associated with carriers. Transmission events from prior bed occupants with CDI (n = 2) or carriers (n = 2) were identified in 4 of 56 cases. Conclusions. In our hospital with an established infection control program designed to contain transmission from symptomatic CDI patients, asymptomatic carriers appear to have played an important role in transmission. Identification and isolation of carriers may be necessary to further reduce transmission of C. difficile in such settings.
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页码:1094 / 1102
页数:9
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