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Surveillance of Clostridium difficile infection in Latvian multidisciplinary teaching hospital

Abstract number: P1485

Aksenoka K., Goonewarden S., Pujate E., Balode A., Miklasevics E., Dumpis U.

Introduction:Clostridium difficile (CD) is the common causative agent of nosocomial diarrhoea. A new highly virulent strain (ribotype 027) has emerged in many European countries. The study was conducted to determine the incidence and main risk factors of CD associated diarrhoea in the large multidisciplinary teaching hospital in Latvia.

Methods: The retrospective analysis of clinical records of all CD cases starting in 2004–2006 was performed. A CD associaciated diarrhoea (CDAD) case was defined as diarrhoea in a hospitalised patient with a stool specimen that tested positive with Culturette CDT latex agglutination (2004–2006) or Toxin A test (2007) tests. A questionnaire was completed for all CDAD patients. In 2007 prospective surveillance of CDAD was initiated. Starting from Sept 2006 CD was cultured and subjected to ribotyping, CD DNA was extracted from stool and the presence of the tcdA and tcdB genes was established by PCR.

Results: A total of 112 patients with CDAD were identified. Their age varied from 20 to 94 years (mean 58.8) and 60.7% were female. The overall 3 years (2004–2006) incidence was 9.6 cases per 10 000 admissions with highest annual incidence in 2004 – 16, 1 cases par 10 000 admitted patients. No death, toxic megacolon or perforation due to CDAD was reported during the study period. Nine patients (8%) had pseudo-membranous colitis confirmed by colonoscopy, 62, 5% of patients had fever. The most frequent risk factors identified were use of antibiotics (89%), previous hospitalisation in last 6 months (47%) and antacid use (57%).

Thirty-two percent of the patients with CDAD were identified in nephrology ward, 15.2% in gastroenterology ward and 7% in transplantation unit.

From Sept 2006 to Sept 2007 20 CD (tcdA+, tcdB+) isolates were ribotyped. 14 isolates displayed different patterns while 6 isolates were identical according to their ribotype. Identical isolates originated from nephrology and thoracic surgery wards. None of the isolates belonged to ribotype 027.

Conclusions: CD infection in our hospital was associated with relatively low morbidity and mortality. The highest incidence was reported in the department of nephrology. Clonal analysis indicated the presence of local outbreaks involving several departments. The new emerging type 027 was not identified during the active surveillance. Active surveillance and infection control guidelines for outbreak containment should be implemented in order to avoid the rapid spread of the new strain.

Session Details

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