title: An investigation of a nosocomial outbreak of Clostridium difficile by pyrolysis mass spectrometry.
abstract: Isolates from a presumptive nosocomial outbreak of Clostridium difficile infection at a large teaching hospital were typed by pyrolysis mass spectrometry (PMS) and antibiograms. One isolate, from the putative index case, was dissimilar from the outbreak strain, but 24 isolates from 16 patients were indistinguishable by both methods. The outbreak centred on two wards for the acute care of the elderly, with a few cases elsewhere. Transfer of patients appeared to be the route of transmission between wards. There was a significant fall in the incidence of cases following intervention by the Infection Control Unit. This included ward inspection, advice on antibiotic usage and advice on prevention of faecal-oral transfer, particularly by proper handwashing. Subsequent monitoring of C. difficile infection showed a background of sporadic, dissimilar isolates with occasional apparent cross-infection incidents limited to a few patients. In suspected outbreaks, patterns of antibiotic susceptibility may be useful in initial screening, before referral for more sophisticated typing. There was excellent correlation between PMS results, antibiograms and epidemiological information.
authors.affiliation: Department of Medical Microbiology, University Hospital of Wales, Heath Park, Cardiff.
authors.forename: J T
authors.initials: JT
authors.lastname: Magee
authors.forename: J S
authors.initials: JS
authors.lastname: Brazier
authors.forename: I K
authors.initials: IK
authors.lastname: Hosein
authors.forename: C D
authors.initials: CD
authors.lastname: Ribeiro
authors.forename: D W
authors.initials: DW
authors.lastname: Hill
authors.forename: A
authors.initials: A
authors.lastname: Griffiths
authors.forename: C
authors.initials: C
authors.lastname: Da Costa
authors.forename: A J
authors.initials: AJ
authors.lastname: Sinclair
authors.forename: B I
authors.initials: BI
authors.lastname: Duerden
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000145:classification* / Q000187:drug effects; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005853:Geriatrics; D006757:Hospital Units; D006801:Humans; D015994:Incidence; D013058:Mass Spectrometry; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D016037:Single-Blind Method; D014852:Wales / Q000453:epidemiology