Emergence of PCR-ribotype 027 Clostridium difficile-associated disease, Northern France, 2006

Abstract number: 1733_258

Coignard B., Barbut F., Blanckaert K., Thiolet J., Carbonne A., Astagneau P., Petit J., Popoff M., Desenclos J.

Background:Clostridium difficile (CD)-associated disease (CDAD) has been recognized as an increasing cause of nosocomial infections (NI) since 2003 when a 027 epidemic strain emerged in Northern America and Europe. To timely detect and control CDAD clusters in France, the Institut de Veille Sanitaire (InVS) and regional infection control coordinating centres (CClin) strengthened the surveillance of NI and set up with the Anaerobe national reference centre (NRC) a network of regional laboratories to characterise CD isolates. We describe the introduction and spread of 027 CDAD in northern France in 2006.

Methods: Using ECDC case definitions, CDAD were notified by healthcare facilities (HCF) to CClin and district health departments through the mandatory national NI early warning and response system. CD strains were sent to the regional laboratories and NRC for confirmatory testing and PCR-ribotyping. CClin assisted HCF in the investigation and implementation of control measures. InVS coordinated the investigation and centralised epidemiological and microbiological data.

Results: The first cluster of 027 CDAD occurred in a HCF of the Nord – Pas de Calais region in April 2006 and accounted for 41 cases. Until November 2006, 30 HCF and 3 nursing homes (NH) notified 400 CDAD cases: 23 facilities had clusters of which 7 with 10 cases or more. Among 387 cases diagnosed in HCF, 328 (85%) were healthcare-associated and 54 (14%) community-acquired. Cases occurred mostly among elderly patients in geriatric or rehabilitation wards; 105 (27%) patients died; 22 (6%) deaths were attributed to CDAD. Of 236 C. difficile strains obtained from stool, 167 (71%) (31 HCF and 2 NH) belonged to the 027 epidemic strain. As of November 7th, 6 clusters were still considered as active. Intensive control measures were needed and included contact precautions, reinforcement of handwashing, glove use, environmental cleaning, and patients' isolation/cohorting. In other French regions, 49 HCF notified 138 cases with 60 strains sent for typing: none belonged to the 027 epidemic strain.

Conclusion: Our data confirm the emergence and spread of the 027 epidemic strain in France, which is presently clustered in the Northern region. This is probably related to close relationships with Northern Europe countries previously affected by this strain (United Kingdom, Belgium and The Netherlands). Control of 027 CDAD needs timely, organised and intensive surveillance and infection control resources.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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