An outbreak of Clostridium difficile infections due to new PCR ribotype 826: epidemiologic and microbiologic analyses

作者：Crobach M J T; in 't holt A F Voor; Knetsch C W; van Dorp S M; Bras W; Harmanus C^*; Kuijper E J; Vos M C^*

来源：Clinical Microbiology and Infection, 2018, 24(3): 309.e1-309.e4.

DOI：10.1016/j.cmi.2017.08.014

• Clostridium difficile
• Epidemiology Infection control
• Outbreak Surveillance

Objectives: To investigate an unusual outbreak of five patients with a total of eight episodes of a Clostridium difficile infection on a gastrointestinal surgical ward of a Dutch tertiary-care, university-affiliated hospital.
Methods: Clinical case investigations and laboratory analyses were performed. Laboratory analyses included PCR ribotyping, multiple-locus variable-number tandem repeat analysis typing, toxin typing, antimicrobial susceptibility testing and whole genome sequencing.
Results: The outbreak was associated with recurrent and severe disease in two of five patients. All episodes were due to a unique ribotype that was not recognized in the collection of an international network of reference laboratories and was assigned PCR ribotype 826. PCR ribotype 826 is a toxin A-,toxin Be and binary toxinepositive ribotype which according to molecular typing belongs to clade 5 and resembles the so-called hypervirulent ribotype 078. The presence of a clonal outbreak was confirmed by whole genome sequencing, yet the source of this newly identified ribotype remained unclear.
Conclusions: This newly identified C. difficile PCR ribotype 826 is part of clade 5 and might also have increased virulence. The recognition of this outbreak highlights the need for ongoing C. difficile infection surveillance to monitor new circulating ribotypes with assumed increased virulence.

• 出版日期2018-3