The role of hospital environment and the hands of medical staff in the transmission of the &lt;i&gt;
Clostridioides (Clostridium) difficile&lt;/i&gt; infection

Kabała, Monika; Aptekorz, Małgorzata; Martirosian, Gayane

doi:10.13075/mp.5893.00856

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…5 C. difficile spores are resistant to many factors (alcohol -present in disinfectants, UV radiation, gamma radiation, etc.). 6 C. difficile spores, after being released by infected patients, are the main cause of the CDI spreading among hospitalized patients. 7 To recognize hospital transmission of C. difficile and outbreak the multilocus variable number tandem repeat analysis (MLVA) technique is proposed.…”

Section: Introductionmentioning

confidence: 99%

Clostridioides difficile Ribotype 027 (RT027) Outbreak Investigation Due to the Emergence of Rifampicin Resistance Using Multilocus Variable-Number Tandem Repeat Analysis (MLVA)

Kabała¹,

Gofron²,

Aptekorz³

et al. 2021

IDR

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The aim of this study was Clostridioides difficile outbreak investigation due to the emergence of rifampicin resistant ribotype 027 (RT 027) fecal isolates from patients of Polish tertiary care hospital between X. 2017 and II. 2018 using multilocus variable tandem repeat analysis (MLVA). Materials and Methods: Twenty-nine C. difficile fecal isolates from patients of tertiary care hospital in Southern Poland were ribotyped and analyzed by MLVA. Multiplex PCR (mPCR) for genes encoding GDH (gluD), toxins A (tcdA)/ B (tcdB), 16S rDNA and binary toxin genes (ctdA and ctdB) was performed. The antibiotic susceptibility profile was determined by E-test. Results: The A, B and binary toxins encoding genes were detected in all 29 C. difficile strains which were sensitive to metronidazole, vancomycin and were resistant to erythromycin, clindamycin, and moxifloxacin; resistance to imipenem demonstrated 97%, to rifampicin -45% isolates. C. difficile strains could be grouped by MLVA into 5 distinct clusters, and the largest cluster II contains 16 strains. The comparison of rifampicin GM MIC of cluster II (n=16 strains) with all others (n=13) showed that strains from clusters I, III, IV and V possessed significantly (p <0.005) higher GM MIC and were more resistant to rifampicin. Conclusion: MLVA analysis proved transmission and recognized outbreak due to multidrugresistant RT 027 C. difficile among patients of tertiary care hospital in Southern Poland. The reason for this is probably the widespread occurrence of spores in the hospital environment, which includes, among others, neglect of hygienic procedures and epidemic supervision. High resistance to imipenem (97%) and to rifampicin (45%) among C. difficile RT 027 Silesian isolates is threatening and requires further studies to elucidate this phenomenon.

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Section: Introductionmentioning

confidence: 99%

Clostridioides difficile Ribotype 027 (RT027) Outbreak Investigation Due to the Emergence of Rifampicin Resistance Using Multilocus Variable-Number Tandem Repeat Analysis (MLVA)

Kabała¹,

Gofron²,

Aptekorz³

et al. 2021

IDR

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“…In the literature, described cases of CDI in ICUs do not establish the precise location of the occurrence of C. difficile spores [ 29 , 31 , 32 ]. The most frequent location of the occurrence of C. difficile spores is the side railing of patients’ beds; however, in our study, they were not detected in this location and were only present on the bed linens [ 21 , 33 ]. Albrecht & Pituch (2013) also point out that a patient’s stay in the Intensive Care Unit itself is one of the reasons for infection with C. difficile [ 34 ].…”

Section: Discussionmentioning

confidence: 74%

Detection and Analysis of Clostridioides difficile Spores in a Hospital Environment

Kiersnowska

Lemiech-Mirowska

Michałkiewicz

et al. 2022

IJERPH

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Clostridioides difficile, due to its long survival time in a hospital environment, is considered to be one of the most frequent factors in healthcare-associated infections. Patient care requires not only rapid and accurate diagnosis, but also knowledge of individual risk factors for infections, e.g., with C. difficile, in various clinical conditions. The goal of this study was to analyse the degree of contamination of a hospital environment with C. difficile spores. Culturing was performed using C diff Banana BrothTM medium, which enables germination of the spores of these bacteria. Samples were collected from inanimate objects within a hospital environment in a specialist hospital in Poland. The results of the study demonstrated the presence of 18 positive samples of Clostridioides spp. (15.4%). Of these, C. difficile spores were detected in six samples, Clostridioides perfringens in eight samples, Clostridioides sporogenes in two samples and Clostridioides innocuum and Clostridioides baratii in one sample each. Among the six samples of C. difficile, a total of four strains which produce the B toxin were cultured. The binary toxin related to ribotype 027 was not detected in our study. Nosocomial infection risk management is a significant problem, mainly concerning the issues of hygiene maintenance, cleaning policy and quality control, and awareness of infection risk.

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“…The effectiveness of the disinfection process may be evaluated in different ways (31). However, none of the com-monly used methods provides more information about spores in the hospital environment.…”

Section: Discussionmentioning

confidence: 99%

Clostridium perfringens Spores in Urology Hospital

Gofron

Szarek

Aptekorz

et al. 2022

Jundishapur J Microbiol

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Background: Clostridium spp. spores are resistant to many factors, including alcohol-based disinfectants. The presence of clostridial spores in a hospital environment may lead to infection outbreaks among patients and health care workers. Objective: This study aimed to detect clostridial spores in aurology hospital using C diff Banana Broth™ and assess the antibiotic sensitivity and toxinotypes of isolates. Methods: After diagnosing COVID-19 in medical staff and closing an 86-bed urology hospital in 2020 for H2O2 fogging, 58 swabs from the hospital environment were inoculated to C diff Banana Broth™, incubated at 37°C for 14 days, checked daily, and positive broths were sub-cultured anaerobically for 48 h at 37°C. After identification, multiplex PCR (mPCR) was performed for Clostridium perfringens, C. difficile toxin genes, and MIC determination. Results: In this study, 16.58 (~ 28%) strains of Clostridium spp. were cultured: 11 - C. perfringens, 2 - C. baratii, and 1 each of C. paraputrificum, C. difficile, and C. clostridioforme. Moreover, C. difficile produced all toxins, and 11 C. perfringens consisted of 1 cpa, 7 cpb2, 2 cpiA, and 1 cpb gene-positive. All isolates were sensitive to metronidazole, vancomycin, moxifloxacin, penicillin/tazobactam, and rifampicin. Two out of the 11 C. perfringens strains were resistant to erythromycin and clindamycin. Conclusions: Regardless of the performed H2O2 fogging, antibiotic-resistant, toxigenic strains of C. perfringens (69%) obtained from the urology hospital environment were cultured using C diff Banana Broth™, indicating the need to develop the necessary sanitary and epidemiological procedures in this hospital.

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The role of hospital environment and the hands of medical staff in the transmission of the <i> Clostridioides (Clostridium) difficile</i> infection

Cited by 11 publications

References 27 publications

Clostridioides difficile Ribotype 027 (RT027) Outbreak Investigation Due to the Emergence of Rifampicin Resistance Using Multilocus Variable-Number Tandem Repeat Analysis (MLVA)

Clostridioides difficile Ribotype 027 (RT027) Outbreak Investigation Due to the Emergence of Rifampicin Resistance Using Multilocus Variable-Number Tandem Repeat Analysis (MLVA)

Detection and Analysis of Clostridioides difficile Spores in a Hospital Environment

Clostridium perfringens Spores in Urology Hospital

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