An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.
An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.
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An outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments.To determine what strikketøy oppbevaring hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.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).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 here 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.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.