Report of an outbreak of Clostridium difficile infection caused by ribotype 053 in a neurosurgery unit

Abstract

Background: We describe an outbreak of Clostridium difficile infection (CDI) with ribotype 053, a possible hypervirulent strain that causes outbreaks, in a neurosurgical unit. Outbreak investigation:The outbreak was investigated by creating a timeline of all toxin positive patients with root cause analysis, supplemented with ribotyping results, hand hygiene and environmental audits. There were five cases of CDI, three caused by ribotype 053 indicating transmission. Infection prevention measures:These included a short period of ward closure to allow enhanced cleaning, including use of vaporised hydrogen peroxide, isolation of infected patients, reinforcement of hand hygiene, education of all staff on C. difficile, reduction of shared bay occupancy from six to four, and addressing staffing levels. Discussion:The patients with ribotype 053 all had long inpatient stays and had required several courses of broadspectrum antibiotics for aspiration pneumonia. They also required enteral feeding, which can cause diarrhoea, and during long inpatient stays they had multiple toxin negative faecal samples making clinical diagnosis of CDI difficult. Hence they were not isolated promptly, leading to transmission. This is the first reported outbreak of C. difficile ribotype 053 in the UK and highlights the unique aspects of an outbreak in neurosurgical patients.

Clostridioides (Formerly Clostridium) difficile Infection During Hospitalization Increases the Likelihood of Nonhome Patient Discharge

“…Ribotype 001 has been shown to cause severe disease during an epidemic in the Czech Republic [24], and has also been shown to be a significant causative ribotype for transmission events between patients [25]. Our ribotyping assay does not distinguish between ribotypes 053 and 163; however, both ribotypes have been associated with epidemic spread or severe disease in the past [26,27]. This is one of the first studies documenting a higher level of discharge care associated with these ribotypes.…”