Characterisation and management of healthcare onset Clostridiumdifficile associated diarrhoea in a hyperendemic region in Germany

Abstract number: 1733_1419

Weil H-P., Mattner F., van den Berg R., Gastmeier P., Kuijper E., Fischer-Brügge U.

Objectives: To investigate whether intensifying infection control measures or an antibiotic use programme is effective to reduce C. difficile incidence rates in three German hospitals (geriatrics [A], diabetology [B] and internal medicine [C]).

Methods: A case of CDAD was defined as a patient with diarrhoea and a positive assay for C. difficile toxin A/B. Medication use was subtracted from an electronic pharmacy database. The strains were analysed by PCR-ribotyping and pulsed-field gel electrophoresis (PFGE) and the antibiotic susceptibility was determined by E-test.

Results: In 2005, 120, 57 and 123 patients developed CDAD in hospital A, B, or C, respectively. Isolated strains (n = 54) belonged to the two PCR ribotypes 001 (A and C) and/or 046 (A and B), whereas typing by PFGE (n = 38) revealed 9 different strains. Three strains accounted for at least 6, 10, and 9 transmissions in A, B, or C, respectively. The strains were resistant towards erythromycin (89%), clindamycin (96%) and all quinolones (95%). In April 2006 A and B installed infection control measures and reduced the fluoroquinolone use, B also reduced the use of clindamycin. A reduced the incidence rate by 70%, whereas B could not lower the incidence rate. C switched from cefotaxime to ampicillin/sulbactam without special infection control measures, thereby reducing the incidence rate by 76%.

Conclusions: Multiresistant C. difficile PCR ribotypes 001 and 046 are hyperendemic in northwest Germany. PFGE typing, rather than PCR-ribotyping, allows the study of nosocomial transmissions. Infection control measures should be installed and the use of fluoroquinolones, clindamycin and cephalosporins should be restricted.