Fulltext

Epidemiology of Clostridium difficile -associated disease at University Hospital Basel including molecular characterisation of the isolates 2006-2007

Fenner, L. ; Frei, R. ; Gregory, M. ; Dangel, M. ; Stranden, A. ; Widmer, A.

In: European Journal of Clinical Microbiology & Infectious Diseases, 2008, vol. 27, no. 12, p. 1201-1207

Add to personal list
    Title
    • Epidemiology of Clostridium difficile -associated disease at University Hospital Basel including molecular characterisation of the isolates 2006-2007
    Author
    • Fenner, L.. Microbiology Laboratory, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Frei, R.. Microbiology Laboratory, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Gregory, M.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Dangel, M.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Stranden, A.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    • Widmer, A.. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • European Journal of Clinical Microbiology & Infectious Diseases, 2008, vol. 27, no. 12, p. 1201-1207. Springer-Verlag
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:321315
    Summary
    A prospective study was conducted during a one-year period between 2006 and 2007 to describe the epidemiology of Clostridium difficile-associated disease (CDAD) at University Hospital Basel, Switzerland (UHBS) and to determine phenotypic and genotypic features of C. difficile strains isolated at the Microbiology Laboratory UHBS including strains from regional non-university hospitals. We prospectively identified 78CDAD cases at UHBS with an incidence of 2.65/1,000 hospitalised patients or 2.3/10,000 patient-days. Sixteen patients (20.5%) were infected with clindamycin-resistant strains of PCR-ribotype 027 during an outbreak at the geriatric hospital. Among 124 single-patient isolates, 28 (22.6%) were resistant to moxifloxacin and 34 (27.4%) were resistant to clindamycin, but all remained susceptible to metronidazole and vancomycin. Of 102 toxigenic isolates, 19 (18.7%) had an 18-bp deletion in the tcdC gene, eight (7.8%) a 39-bp deletion, and one (1.0%) a 54-bp deletion. Genes for binary toxin were present in 27 (21.8%). PCR-ribotype 027 was associated with older age (median age 83.5 vs. 65.5years, p < 0.0001) and longer duration of hospitalisation before onset of disease (median 15.5 vs. 9days, p = 0.014) with a trend towards higher crude mortality, more severe disease, and previous use of macrolides compared to ribotype non-027. Overall, severe disease correlated with use of a nasogastric tube and surprisingly shorter duration of hospitalisation before onset of disease. Today, laboratory-based and epidemiological surveillance systems are required to monitor CDAD cases and emergence of new epidemic strains