A Clostridium difficile 027 epidemic in a hospital in Vienna, Austria, 20082009
Abstract number: P1469
Kasper S., Kanitz E.E., Indra A., Watkins-Riedel T., Masoud H., Eberl S., Huhulescu S., Allerberger F., Schmid D.
Objectives: From January to August 2009, 174 cases of C. difficile infections (CDI), including 38 cases of infection with C. difficile ribotype 027(027CDI) occurred in a Viennese hospital (HX). Previously, in 2008, 11 cases of 027CDI were identified in Austria. The objective was to describe the 027 CDI outbreak by time, place, person and to ascertain antibiotic exposure prior to diarrhoea onset, the frequency of recurrent CDI and the 30-day mortality.
Methods: Surveillance case definitions were given by the Study Group for Clostridium difficile (ESGCD). An outbreak case was defined as a patient with 027CDI, who became ill between December 2008 and August 2009 in HX or who was epidemiologically linked to HX. The epidemiological link was defined as stay at HX within 4 weeks prior to 027CDI occurrence or as contact to a 027CDI case of HX. A recurrent CDI was defined as the occurrence of a second episode of CDI within 60 days after the first episode. PCR ribotyping of C. difficile isolates was performed by the National Reference Laboratory for C. difficile, AGES. Medical charts of the 027 cases of HX were reviewed for recurrent episodes, antibiotic exposure prior to diarrhoea onset and outcome.
Results: A total of 38 027CDI outbreak cases occurred in HX and another 12 cases of 027 CDI in further 5 Viennese hospitals were epidemiologically linked to the 027CDI outbreak Twenty-four of 38 cases were male (60%), the median age was 80 years (range: 3198 years). The proportion of recurrence was 15.8% (6/38) and the 30-day mortality was 34.2% (13/38). Medical records were available for 27 (66%) outbreak cases. All these received antibiotics prior to diarrhoea onset (b-lactam antibiotics: 55.6%, fluoroquinolones: 59.3%). ESGCD control measures were implemented in the third week of July.
Conclusion: Non-compliance to evidence based control measures as recommended by ESGCD resulted in a rapid spread of a high virulent CD strain, which caused a very high patient mortality. Following the measure implementation, the hospital-based CD surveillance indicated a decreasing trend of all CDI cases in HX within the past three months. The findings of the outbreak investigation underline the importance of ribotyping in elucidating links between separate hospital clusters.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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