Investigation of a Clostridium difficile cluster by multilocus sequence typing in a bone marrow transplant unit

Hu, Carol; Sunday, Richard; Bruminhent, Jackrapong; Bobik, Brent; Wagner, John L.; Weiss, Mark A.; Flomenberg, Phyllis; Wang, Zixuan

doi:10.1016/j.ajic.2014.02.008

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…This represents a possible cross-transmission event. Additionally, in the third quarter of 2012, there was a cluster of 3 patients who acquired CDI in the same room in the BMT unit but had 3 distinct strain types [10]. Of note, the NAP 1 epidemic strain (strain type 1), which has unique sequence features and is associated with an increased severity of CDI, was present in only 1 of 22 patients (4.5%) [11,12].…”

Section: Difficile Strainsmentioning

confidence: 99%

Clostridium Difficile Colonization and Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation

Bruminhent

Wang

et al. 2014

Biology of Blood and Marrow Transplantation

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There was an increase in the Clostridium difficile infection (CDI) rate in our bone marrow transplantation unit. To evaluate the role of unit-based transmission, C. difficile screening was performed on adult patients admitted for hematopoietic stem cell transplantation (HSCT) over a 2-year period, and C. difficile isolates were typed. C. difficile testing was performed using a 2-step C. difficile glutamate dehydrogenase antigen plus toxin A/B enzyme immunoassay (EIA) and cytotoxin assay (or molecular toxin assay). Multilocus sequence typing (MLST) was performed on toxin-positive whole stool samples. A retrospective chart review was performed on all patients with a positive toxin assay. Sixteen of 150 patients (10.7%) had toxigenic C. difficile colonization (CDC) on admission. The overall incidence of CDI within 100 days after HSCT was 24.7% (37 of 150). The median time to diagnosis of CDI was 3.5 days after HSCT. In an adjusted logistic regression model, CDC on admission was a significant risk factor for CDI (odds ratio, 68.5; 95% confidence interval, 11.4 to 416.2). MLST on 22 unit patient toxin-positive stool specimens revealed 15 distinct strain types. Further analysis identified at least 1 potential cross-transmission event; some events may have been missed because of incomplete typing from other specimens. Despite aggressive infection control interventions, there was no decline in the number of CDI cases during the study period. These data suggest that prior CDC plays a major role in CDI rates in this high-risk patient population. It remains unclear if CDI was cross-transmitted in the unit.

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Section: Difficile Strainsmentioning

confidence: 99%

Clostridium Difficile Colonization and Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation

Bruminhent

Wang

et al. 2014

Biology of Blood and Marrow Transplantation

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“…12,13 Transmission patterns of C. difficile in acute care settings from geographically defined populations have been elucidated by the application of various fingerprinting techniques. By characterizing CDI cases detected by a low-sensitivity enzyme immunoassay test, Walker et al 14 showed that 37% of all C. difficile cases on a renal transplant unit could be attributed to ward-based transmission, much higher than the overall 23% suspected transmission among all hospitalized patients in this study.…”

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confidence: 99%

Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant

Kamboj

Sheahan

Sun

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant. SETTING Stem cell transplant unit at a tertiary care cancer center. METHODS Serially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains. RESULTS During the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases. CONCLUSIONS Most cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.

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Investigation of a Clostridium difficile cluster by multilocus sequence typing in a bone marrow transplant unit

Cited by 2 publications

References 8 publications

Clostridium Difficile Colonization and Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation

Clostridium Difficile Colonization and Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation

Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant

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