An outbreak of Clostridium difficile infections due to new PCR ribotype 826: epidemiologic and microbiologic analyses. (March 2018)

• Record Type: Journal Article
• Authors: Crobach, M.J.T.; Voor in 't holt, A.F.; Knetsch, C.W.; van Dorp, S.M.; Bras, W.; Harmanus, C.; Kuijper, E.J.; Vos, M.C.
• Is Part Of: Clinical microbiology and infection. Volume 24:Number 3(2018)
• Page Start: 309.e1
• Page End: 309.e4
• Publication Date: 2018-03
• Subjects: Clostridium difficile -- Epidemiology -- Infection control -- Outbreak -- Surveillance; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2017.08.014
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: 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 B– and binary toxin–positive 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.