Changing Epidemiology of Clostridium difficile Infection Following the Introduction of a National Ribotyping-Based Surveillance Scheme in England

Wilcox, Mark H.; Shetty, Nandini; Fawley, Warren N.; Shemko, M.; Coen, Pietro G.; Birtles, Andrew; Cairns, M. D.; Curran, Martin D.; Dodgson, Kirsty; Green, S. M.; Hardy, Katherine; Hawkey, Peter M.; Magee, Jeffrey C.; Sails, Andrew D.; Wren, M. W. D.

doi:10.1093/cid/cis614

Cited by 218 publications

(167 citation statements)

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“…These epidemiological changes coincided with the emergence and epidemic spread of C. difficile strains belonging to the PCR ribotype (RT) 027/North American pulsedfield gel electrophoresis type 1 (NAP1) (6). Indeed, RT027 became the predominant strain in many geographical regions, as documented in different epidemiological studies, and, since 2005, several countries have conducted epidemiological surveillance to monitor its spread (7,8). It has been reported to occur in at least 38 U.S. states and in 16 European countries, being also responsible for outbreaks (7, 9).…”

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confidence: 99%

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

et al. 2015

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e Clostridium difficile infection (CDI) became a public health problem for the global spreading of the so-called hypervirulent PCR ribotypes (RTs) 027 and 078, associated with increases in the transmission and severity of the disease. However, especially in Europe, several RTs are prevalent, and the concept of hypervirulence is currently debated. We investigated the toxin and resistance profiles and the genetic relatedness of 312 C. difficile strains isolated in a large Italian teaching hospital during a 5-year period. We evaluated the role of CDI-related antibiotic consumption and infection control practices on the RT predominance in association with their molecular features and transmission capacity. Excluding secondary cases due to nosocomial transmission, RT018 was the predominant genotype (42.4%) followed by RT078 (13.6%), while RT027 accounted for 0.8% of the strains. RT078 was most frequently isolated from patients in intensive care units. Its prevalence significantly increased over time, but its transmission capacity was very low. In contrast, RT018 was highly transmissible and accounted for 95.7% of the secondary cases. Patients with the RT018 genotype were significantly older than those with RT078 and other RTs, indicating an association between epidemic RT and age. We provide here the first epidemiological evidence to consider RT018 as a successful epidemic genotype that deserves more attention in clinical practice.C lostridium difficile infection (CDI) is one of the most common hospital-acquired infections and the main known cause of antibiotic-associated diarrhea in hospitals in industrialized countries (1). Previous antibiotic treatment, hospitalization, old age, and underlying diseases represent major risk factors for CDI. The disease spectrum ranges from mild diarrhea to severe pseudomembranous enterocolitis, sepsis, and death (2, 3).In the past decade, many countries in North America and Europe have registered an increase in CDI rates and related severity and mortality (4, 5). These epidemiological changes coincided with the emergence and epidemic spread of C. difficile strains belonging to the PCR ribotype (RT) 027/North American pulsedfield gel electrophoresis type 1 (NAP1) (6). Indeed, RT027 became the predominant strain in many geographical regions, as documented in different epidemiological studies, and, since 2005, several countries have conducted epidemiological surveillance to monitor its spread (7,8). It has been reported to occur in at least 38 U.S. states and in 16 European countries, being also responsible for outbreaks (7, 9). Moreover, an increase in community-acquired CDI has been reported; in Europe, this phenomenon correlates with the diffusion of RT078/NAP7 or NAP8 which, like RT027, has been associated with higher disease severity and attributable mortality (1, 10).RT027 and RT078 are often referred to as hypervirulent genotypes of C. difficile, but this definition is not without controversy. Though this term denotes an increase in virulence, it has often been misused to ident...

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Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

et al. 2015

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“…Clearly, the NAP1/BI/027 ribotype became the predominant strain in many geographical locations during the past decade, and this has been well documented in several large-scale epidemiological studies, such as the one performed by the National Ribotype-Based Surveillance Scheme in England (171). Results from this surveillance program demonstrate a correlation between the frequency of NAP1/BI/027 infections and increased mortality.…”

Section: History and Emergence Of Nap1/027/bi Strainsmentioning

confidence: 82%

Variations in Virulence and Molecular Biology among Emerging Strains of Clostridium difficile

Hunt

Ballard

2013

Microbiol Mol Biol Rev

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SUMMARY Clostridium difficile is a Gram-positive, spore-forming organism which infects and colonizes the large intestine, produces potent toxins, triggers inflammation, and causes significant systemic complications. Treating C. difficile infection (CDI) has always been difficult, because the disease is both caused and resolved by antibiotic treatment. For three and a half decades, C. difficile has presented a treatment challenge to clinicians, and the situation took a turn for the worse about 10 years ago. An increase in epidemic outbreaks related to CDI was first noticed around 2003, and these outbreaks correlated with a sudden increase in the mortality rate of this illness. Further studies discovered that these changes in CDI epidemiology were associated with the rapid emergence of hypervirulent strains of C. difficile , now collectively referred to as NAP1/BI/027 strains. The discovery of new epidemic strains of C. difficile has provided a unique opportunity for retrospective and prospective studies that have sought to understand how these strains have essentially replaced more historical strains as a major cause of CDI. Moreover, detailed studies on the pathogenesis of NAP1/BI/027 strains are leading to new hypotheses on how this emerging strain causes severe disease and is more commonly associated with epidemics. In this review, we provide an overview of CDI, discuss critical mechanisms of C. difficile virulence, and explain how differences in virulence-associated factors between historical and newly emerging strains might explain the hypervirulence exhibited by this pathogen during the past decade.

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“…Time from sampling to test result also varies considerably by pathogen, but negative results do generally lead to patients being removed from isolation. Strain typing information is commonly used if a C. difficile outbreak is suspected, probably reflecting the easy access to ribotyping through the Clastridium Difficile Ribotyping Network (CDRN), 28 but is used less so outside of these situations. Many patients complete antibiotic therapy outside of hospital and a significant minority are subsequently readmitted for additional treatment.…”

Section: Discussionmentioning

confidence: 99%

Can rapid integrated polymerase chain reaction-based diagnostics for gastrointestinal pathogens improve routine hospital infection control practice? A diagnostic study

Pankhurst

Macfarlane-Smith

Buchanan

et al. 2014

Health Technology Assessment

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This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/13/35. The contractual start date was in April 2010. The draft report began editorial review in September 2013 and was accepted for publication in January 2014. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by t...

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Changing Epidemiology of Clostridium difficile Infection Following the Introduction of a National Ribotyping-Based Surveillance Scheme in England

Cited by 218 publications

References 16 publications

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

Clostridium difficile PCR Ribotype 018, a Successful Epidemic Genotype

Variations in Virulence and Molecular Biology among Emerging Strains of Clostridium difficile

Can rapid integrated polymerase chain reaction-based diagnostics for gastrointestinal pathogens improve routine hospital infection control practice? A diagnostic study

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