High Prevalence and Frequent Acquisition of Clostridium difficile Ribotype 002 Among Nursing Home Residents in Hong Kong

Abstract

OBJECTIVETo determine the incidence and risk factors associated with Clostridium difficile colonization among residents of nursing homes and to identify the ribotypes of circulating C. difficile strains.DESIGNA prospective cohort study with a follow-up duration of 22 months.SETTINGNursing homes.PARTICIPANTSOf the 375 residents in 8 nursing homes, 300 residents (80.0%) participated in the study. A further prospective study of 4 nursing homes involving 141 residents with a minimum of 90 days of follow-up was also performed.METHODSBaseline and 90-day stool cultures were obtained; additional stool cultures were obtained for residents who had been discharged from hospitals. Polymerase chain reaction (PCR) ribotyping and slpA typing were performed for all C. difficile strains isolated.RESULTSToxigenic C. difficile was isolated in 30 residents (10%) at baseline, and 9 residents (7.3%) had acquired toxigenic C. difficile in the nursing homes. The presence of nasogastric tube was an independent risk factor (adjusted odds ratio, 8.59; 95% confidence interval, 1.18-62.53; P=.034) for C. difficile colonization. The Kaplan-Meier estimate of median carriage duration was 13 weeks. The C. difficile ribotypes most commonly identified were 002 (40.8%), 014 (16.9%), 029 (9.9%), and 053 (8.5%).CONCLUSIONSThe high incidence of C. difficile colonization and the overrepresentation of C. difficile ribotype 002 confirmed the contribution of nursing home residents to C. difficile transmission across the continuum of care. An infection control program is needed in long-term care.Infect Control Hosp Epidemiol 2018;782-787.

Epidemiology of Clostridioides difficile infections, France, 2010 to 2017

“…NRL microbiology data show the emergence of PCR ribotype 002 and PCR ribotype 106 from 2012 to 2017. PCR ribotype 002 has been shown endemic in some nursing homes in Hong-Kong [27] and PCR ribotype 106 has been responsible for outbreaks in vascular surgery [28].…”

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

“…This goal is especially important given that residents of LTCFs are at increased risk of colonisation with resistant organisms and facilitate the spread of these organisms due to their close proximity to other residents and regular contact with hospitals, LTCF workers and the community 13–18. The widespread use of antibiotics by LTCF residents also puts them at risk of related infections, such as Clostridioides difficile , which are subsequently easily spread to contacts 19…”