Successful Management of a Clostridioides difficile Ribotype 027 Outbreak with a Lean Intervention Bundle.

Kuenzli, Andrea B.; Burri, Silvie; Casanova, Carlo; Sommerstein, Rami; Buetti, Niccolo; Seth-Smith, Helena Mb; Bodmer, Thomas; Egli, Adrian; Marschall, Jonas (2020). Successful Management of a Clostridioides difficile Ribotype 027 Outbreak with a Lean Intervention Bundle. The journal of hospital infection, 106(2), pp. 240-245. Elsevier 10.1016/j.jhin.2020.07.034

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BACKGROUND

In a 2015 point prevalence study, Clostridioides difficile 027, a hypervirulent ribotype, was absent from healthcare institutions in Switzerland. In late 2016, we detected an outbreak of C. difficile infection (CDI) with ribotype 027 occurring across several hospitals in the same hospital network.

METHODS

The first cases of CDI due to ribotype 027 triggered an outbreak investigation, including whole genome sequencing (WGS) to identify outbreak strains.

FINDINGS

We identified 28 patients with CDI caused by ribotype 027 between December 2016 and December 2017, out of which twenty were caused by a single clone. Commonalities among these patients were hospitalization in the same room or on the same ward, receiving care from the same healthcare workers, and shared toilet areas. In addition to the epidemiological links suggesting possible transmission pathways between cases, WGS confirmed the clonality of this C. difficile 027 outbreak. The outbreak was contained by isolation precautions, raising awareness among healthcare workers, harmonizing diagnostic algorithms, and switching to a sporicidal agent for environmental disinfection. Of note, neither default gowning and gloving nor handwashing with water and soap were implemented.

CONCLUSIONS

This C. difficile 027 outbreak was recognized belatedly due to lack of screening for this ribotype in some hospitals, and was contained by a swift response with simple infection prevention measures and adapting the laboratory approach. In order to have a better understanding of C. difficile epidemiology, diagnostic approaches should be standardized, CDI declared notifiable, and longitudinal data on prevalent ribotypes collected in countries where this is not established.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases > General Bacteriology

UniBE Contributor:

Künzli, Andrea Brigitte; Burri, Silvie; Casanova, Carlo; Sommerstein, Rami; Buetti, Niccolò Ivo Marco-Aurelio and Marschall, Jonas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1532-2939

Publisher:

Elsevier

Funders:

[42] Schweizerischer Nationalfonds

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

25 Aug 2020 11:30

Last Modified:

30 Sep 2020 01:32

Publisher DOI:

10.1016/j.jhin.2020.07.034

PubMed ID:

32745592

Uncontrolled Keywords:

BI/NAP1/027 Clostridioides difficile outbreak ribotype 027 whole genome sequencing

BORIS DOI:

10.7892/boris.145772

URI:

https://boris.unibe.ch/id/eprint/145772

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