Transmission of<i>Clostridium difficile</i>from asymptomatically colonized or infected long-term care facility residents

Donskey, Curtis J.; Sunkesula, Venkata; Stone, Nimalie D.; Gould, Carolyn V.; McDonald, L. Clifford; Samore, Matthew H.; Mayer, Jeanmarie; Pacheco, Susan M.; Jencson, Annette; Sambol, Susan P.; Petrella, Laurica A.; Gulvik, Christopher A.; Gerding, Dale N.

doi:10.1017/ice.2018.106

Cited by 41 publications

(27 citation statements)

References 38 publications

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“…Incomplete sampling of outbreaks is not unlikely because asymptomatic patients are only rarely examined for colonization with C. difficile [31–33] even though they may constitute an important reservoir for transmission. Indeed, some of the outbreaks investigated here did consist of more than one HC2 cluster ().…”

Section: Resultsmentioning

confidence: 99%

A publicly accessible database for Clostridioides difficile genome sequences supports tracing of transmission chains and epidemics

Frentrup¹,

Zhou

Steglich

et al. 2020

Microbial Genomics

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Clostridioides difficile is the primary infectious cause of antibiotic-associated diarrhea. Local transmissions and international outbreaks of this pathogen have been previously elucidated by bacterial whole-genome sequencing, but comparative genomic analyses at the global scale were hampered by the lack of specific bioinformatic tools. Here we introduce a publicly accessible database within EnteroBase (http://enterobase.warwick.ac.uk) that automatically retrieves and assembles C. difficile short-reads from the public domain, and calls alleles for core-genome multilocus sequence typing (cgMLST). We demonstrate that comparable levels of resolution and precision are attained by EnteroBase cgMLST and single-nucleotide polymorphism analysis. EnteroBase currently contains 18 254 quality-controlled C. difficile genomes, which have been assigned to hierarchical sets of single-linkage clusters by cgMLST distances. This hierarchical clustering is used to identify and name populations of C. difficile at all epidemiological levels, from recent transmission chains through to epidemic and endemic strains. Moreover, it puts newly collected isolates into phylogenetic and epidemiological context by identifying related strains among all previously published genome data. For example, HC2 clusters (i.e. chains of genomes with pairwise distances of up to two cgMLST alleles) were statistically associated with specific hospitals (P<10−4) or single wards (P=0.01) within hospitals, indicating they represented local transmission clusters. We also detected several HC2 clusters spanning more than one hospital that by retrospective epidemiological analysis were confirmed to be associated with inter-hospital patient transfers. In contrast, clustering at level HC150 correlated with k-mer-based classification and was largely compatible with PCR ribotyping, thus enabling comparisons to earlier surveillance data. EnteroBase enables contextual interpretation of a growing collection of assembled, quality-controlled C. difficile genome sequences and their associated metadata. Hierarchical clustering rapidly identifies database entries that are related at multiple levels of genetic distance, facilitating communication among researchers, clinicians and public-health officials who are combatting disease caused by C. difficile .

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Section: Resultsmentioning

confidence: 99%

A publicly accessible database for Clostridioides difficile genome sequences supports tracing of transmission chains and epidemics

Frentrup¹,

Zhou

Steglich

et al. 2020

Microbial Genomics

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“…19 This risk was present even if the patient was simply colonized and asymptomatic. 20,21 A previously published study demonstrated that use of a launderable bed-barrier (BB) in Long-term Acute Care Hospitals (LTACHs) was associated with a 50% reduction in CDIs. 22 The objective of this study was to assess the effectiveness of a BB in conjunction with an ASP at an acute care hospital located in Kentucky, USA.…”

Section: Introductionmentioning

confidence: 99%

Use of a Launderable Bed Barrier and Antibiotic Stewardship to Decrease Hospital Onset Clostridioides difficile Infections in an Acute Care Hospital: A Retrospective Pre/Post Case Study

Hooker

Mallow

McKinney

et al. 2019

Journal of Health Economics and Outcomes Research

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Background: Hospital-onset Clostridioides difficile infection (HO-CDI) is a major source of morbidity and mortality. The objective of this research was to evaluate the reduction in HO-CDI through the use of a launderable bed barrier (BB) and an antibiotic stewardship program (ASP). Methods:A retrospective pre-post study was conducted at an acute care hospital in Kentucky. The preintervention period was September 2014 through March 2016. The BB and the ASP were introduced in April 2016, and the post-intervention period for this study ended September 2018. The rate of HO-CDI was calculated from the actual number of HO-CDI divided by the number of patient days each month. The number of defined daily doses of antibiotic therapy was measured each quarter. Hand disinfection compliance, length-of-stay (LOS), case mix index (CMI), and average age of patients were collected to control for confounding in the regression models.Results: There were 34 HO-CDIs and 42 672 patient days in the pre-intervention period and 31 HO-CDIs and 65 882 patient days in the post-intervention period. The average monthly count of HO-CDI was 1.79 (SD 1.51) and 1.03 (SD 0.96) during the pre-and post-periods, respectively. The average monthly rate (per 10 000 patient-days) was 7.94 (SD 6.30) in the pre-intervention period and 4.71 (SD 4.42) during the post-intervention period. The use of antibiotics decreased by 37% (p <0.0001) over the study period. The combination of the BB and the ASP were associated with a 59% (95% CI 36-96%, p 0.034) reduction in HO-CDI. Conclusions:The use of a launderable BB and the ASP were associated with a statistically and clinically significant reduction in HO-CDI in the acute care hospital setting.

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“…Despite these shared genetic and phenotypic characteristics, in vitro toxin production appeared infections. All the documented transmission events occurred in the BI/RT027 patients (34). Despite the fact that all the CDI cases caused by DQ/RT591 were healthcare associated, WGS did not identify any transmission events between patients because core genome SNP differences were >8 among DQ isolates (Appendix Figure 3) (34).…”

Section: Discussionmentioning

confidence: 99%

“…All the documented transmission events occurred in the BI/RT027 patients (34). Despite the fact that all the CDI cases caused by DQ/RT591 were healthcare associated, WGS did not identify any transmission events between patients because core genome SNP differences were >8 among DQ isolates (Appendix Figure 3) (34). All patients in whom DQ/RT591 was confirmed had received antimicrobial drugs within 90 days before testing, and all patients with a CDI were classified as having a healthcare-associated infection; nearly all cases occurred in the LTCF or spinal cord injury unit.…”

Section: Discussionmentioning

confidence: 99%

Unique Clindamycin-Resistant Clostridioidesdifficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain

Skinner¹,

Petrella²,

Siddiqui³

et al. 2020

Emerg. Infect. Dis.

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Transmission ofClostridium difficilefrom asymptomatically colonized or infected long-term care facility residents

Cited by 41 publications

References 38 publications

A publicly accessible database for Clostridioides difficile genome sequences supports tracing of transmission chains and epidemics

A publicly accessible database for Clostridioides difficile genome sequences supports tracing of transmission chains and epidemics

Use of a Launderable Bed Barrier and Antibiotic Stewardship to Decrease Hospital Onset Clostridioides difficile Infections in an Acute Care Hospital: A Retrospective Pre/Post Case Study

Unique Clindamycin-Resistant Clostridioidesdifficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain

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