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Clinical-epidemiological characterisation of Clostridium difficile – ribotype 053

Abstract number: P1486

Hell M., Greil R., Berr F., Maass M., Schmid D., Huhulescu S., Indra A., Allerberger F.

Objectives:Clostridium difficile associated disease (CDAD) has been changing in its clinical severity and epidemicity. Hypervirulent strains of Clostridium difficile (C.diff.) are causing hospital outbreaks in Europe. This phenomenon may not only be due to PCR ribotype 027. Hospital surveillance programs should therefore not focuse only on this ribotype but also on other potential hypervirulent strains of C.diff. The aims of our surveillance program are to monitor incidence and death rate of CDAD in our hospital, to characterise selected clinical cases by ribotyping and to asses the efficacy of infection control precautions.

Methods: Since February 2006 an active clinically and laboratory based surveillance program has been in place. All patients with diarrhoea are obligatory screened for CDAD. Case definitions according to the Clostridium difficile working group recommendations (ECDC Advisory Forum 2006)were used for case identification and classification. Data collection was done until October 2007.

Results: 514 patients fulfilled the definition criteria of a case of CDAD in a period of 19 months. Of these 514 cases 91 were selected because of a severe course of their CDAD episode, relapse of CDAD and because of having been related in time and/ or space with the severe or relapse cases. All 91 cases were retrospectively subjected to extensive epidemiological and molecular biological investigation including PCR-ribotyping. There was no ribotype 027 found among the isolates from the 91 cases. The most prevalent ribotype found was ribotype 053 (45; 49.5%), whereas 20 of these cases showed a fatal course (44.4%). Ribotype 053 showed a high case-fatality-ratio (0.4) and was also suspected to be highly transmissible. It was responsible for at least two clusters in 2 neighbouring wards in April and May 2007. We were also able to demonstrate twice a survival of Ribotype-053-spores in the hospital environment close to 053 positive patients despite efficacious routine desinfections measures. For that reason ribotyp 053 should be considered as a strain of Clostridium difficile with high transmissibility and high virulence.

Conclusions: Based on ribotyping one major strain was identified in a surveillance period of 19 months. Our findings indicate a high transmissibility and hypervirulence of strain Ribotype 053. Further efforts should be put on molecular-microbiological investigations of this strain and its toxins detecting responsible virulence factors.

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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