Surveillance of Clostridium difficile NAP1/O27 since 2006 in Belgium

Abstract number: P1479

Van Broeck J.V.C., Avesani V., Janssens M., Suetens C., Jans B., Delmée M.

A European prospective study (Barbut et al. 2005) revealed the presence of Clostridium difficile NAP1/O27 strains in the Netherlands, Ireland and Belgium. Since

January 1st 2006 an official reference centre was created in Belgium. The aim of the centre is to help hospitals in managing C. difficile outbreaks and in identifiying and typing their strains.

Objective: We organised a surveillance program of C. difficile associated disease (CDAD) in Belgium, which started in January 2006. The aims were to detect C. difficile clusters, to establish the prevalence of the NAP1/O27 clone, and to prospectively assess the incidence of CDAD in acute care hospitals according to a standardised protocol established by the Belgian Infection Control Society.

Methods: Each participating laboratory was asked to send strains in case of clusters, and for the prospective component, to report monthly denominator data as well as clinical data on every case to the Scientific Institute of Public Health and to send the first five C. difficile isolates every six months to the reference laboratory.

Strains were analysed, after species confirmation, for tcdC deletion (RT-

PCR), binary toxin (RT-PCR), toxinotyping (PCR B1-A3 + RFLP) and ribotyping (RT-PCR). On 92 strains typed as NAP1/O27 we measured minimal inhibitory concentrations of Ciprofloxacin and Moxifloxacin by use of E-test.

Results: From January 2006 until end of october 2007 we confirmed 1401 strains from 93 centres, as C. difficile; 338 strains (24.1%) from 47 centres (50.5%) belonged to ribotype NAP1/O27. The second most prevalent ribotype was ribotype 3 (Brazier's 078) with 68 isolates (5.1%). All 92 strains tested for Moxifloxacin and Ciprofloxacin susceptibility and all of them were resistant to both drugs. The incidence of nosocomial CDAD (onset >2 days of hospital stay) in 32 hospitals having participated to 2 semesters of the prospective surveillance was 1.6 cases per 10000 patient days (95% CI 1.0–2.1) in the second semester of 2006 and 0.9/10000 (95% CI 0.6–1.2) in the first halfyear of 2007.

Conclusions: The NAP1/027 clone has spread all over the country, accounting for 24% of the strains. It is present in more than 50% of the hospitals. In some centres it was clearly implicated in outbreaks but a lot of sporadic cases were also observed.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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