Infection due to C. difficile ribotype 078: first report of cases in the Republic of Ireland

• Published in: The Journal of hospital infection Vol. 75; no. 4; pp. 287 - 291
• Main Authors: Burns, K, Morris-Downes, M, Fawley, W.N, Smyth, E, Wilcox, M.H, Fitzpatrick, F
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2010; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Clostridium difficile; Clostridium difficile - classification; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Outbreaks; DNA Fingerprinting; Feces - microbiology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hospital Mortality; Human bacterial diseases; Humans; Infectious Disease; Infectious diseases; Ireland; Male; Medical sciences; Middle Aged; Multilocus variable analysis; Nursing Homes; Other diseases. Semiology; Outbreak; Prevalence; Recurrence; Ribotype 078; Ribotyping; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Europe; Ireland; Ribotype 078; Multilocus variable analysis; Outbreak; Clostridium difficile; Epidemic; Ribotype; Clostridiales; Diarrhea; Infection; Clostridiaceae; Bacteria; Digestive diseases; Intestinal disease; Public health
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2010.03.025

Summary Clostridium difficile is an important healthcare-associated pathogen. Hypervirulent strains such as those belonging to ribotype 027 have been widely reported in recent years. A second strain associated with hypervirulence is ribotype 078 and the prevalence of Clostridium difficile infection (CDI) due to this ribotype appears to be increasing. This report describes an outbreak, in which 15 cases of CDI due to ribotype 078 were detected in an Irish hospital and from a nursing home in the hospital’s catchment area. C. difficile ribotype 078 accounted for 15% of total isolates submitted for ribotyping. The average age of patients with CDI due to ribotype 078 was 76 years. Forty-six percent of patients experienced recurrence of symptoms within eight weeks of diagnosis and CDI was felt to have directly contributed to five of the eight deaths. Use of enhanced DNA fingerprinting identified clusters within the 15 cases and suggested hitherto unrecognised links between some patients with CDI. Such approaches offer the promise to delineate common sources and transmission routes for C. difficile.