Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Abstract

Objective.To report a large outbreak ofClostridium difficileinfection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.Design.Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.Interventions.Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.Results.A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction betweenC. difficileribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months;P= .003).Conclusion.These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

Prevalence and Genotypic Characteristics of Clostridium difficile in a Closed and Integrated Human and Swine Population

“…The results from the swine isolates are consistent with other studies that have observed that the majority of isolates from swine are PFGE type NAP7 (21). Studies in human health care facilities have identified PFGE type NAP1 (ribotype 027) to be the virulent strain responsible for most of the recent outbreaks in North America and Europe (1,20,27). While no human clinical studies have made explicit mention of NAP7, studies have identified ribotype 078, toxinotype V isolates among human cases, and this is the strain most commonly associated with PFGE type NAP7 (17).…”

NAP1 Strain Type Predicts Outcomes From Clostridium difficile Infection

“…Indeed, fluoroquinolone use has been found to be a risk factor for infection by the NAP1/027 strain [27–29] and the development of fluoroquinolone resistance by the NAP1/027 strain has been suggested to be the primary genetic factor facilitating its spread [29]. Fluoroquinolone restriction has also been reported to be an important component of efforts to control outbreaks of C. difficile from the NAP1/027 strain [30, 31], but further research is needed to determine the utility of the application of this strategy to non-outbreak settings.…”

Detection of Clostridium difficile infection clusters, using the temporal scan statistic, in a community hospital in southern Ontario, Canada, 2006–2011

“…Simply, this event may represent a coincidental occurrence of CDI cases with different strains; however, this cluster may also represent a potential outbreak or possible transmission events. It has been previously reported that different ribotypes may be present in a patient population during a C. difficile outbreak [25]. Additionally, transmission of C. difficile due to environmental contamination or by unidentified patients, staff, or visitors infected or colonized with C. difficile are also possible scenarios.…”