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PLoS One ; 11(8): e0160778, 2016.
Article in English | MEDLINE | ID: mdl-27533048

ABSTRACT

BACKGROUND: An outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study. METHODS: Cases (n = 79), diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316). Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10) was genotyped by Whole Genome Sequencing (WGS). FINDINGS: WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates). Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU) (OR: 2.4, 95% CI 1.0-5.6), longer length of stay (LOS), and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6). Analysis of patients who stayed at the ICU (35 cases; 51 controls), indicated that the use of selective decontamination of the digestive tract (SDD) and a longer LOS in the ICU were associated with CDI risk. INTERPRETATION: In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.


Subject(s)
Clostridioides difficile/classification , Clostridioides difficile/genetics , Clostridium Infections/epidemiology , Disease Outbreaks , Aged , Aged, 80 and over , Case-Control Studies , Clostridium Infections/microbiology , Clostridium Infections/mortality , Cross Infection/epidemiology , Cross Infection/microbiology , Cross Infection/mortality , Decontamination/methods , Female , Gastrointestinal Tract/microbiology , Hospitals, University , Humans , Incidence , Intensive Care Units , Length of Stay , Male , Middle Aged , Netherlands/epidemiology , Ribotyping , Risk Factors
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