title: Surveillance snapshot of Clostridium difficile infection in hospitals across Queensland detects binary toxin producing ribotype UK 244.
abstract: In North America and Europe, the binary toxin positive Clostridium difficile strains of the ribotypes 027 and 078 have been associated with death, toxic megacolon and other adverse outcomes. Following an increase in C. difficile infections (CDIs) in Queensland, a prevalence study involving 175 hospitals was undertaken in early 2012, identifying 168 cases of CDI over a 2 month period. Patient demographics and clinical characteristics were recorded, and C. difficile isolates were ribotyped and tested for the presence of binary toxin genes. Most patients (106/168, 63.1%) were aged over 60 years. Overall, 98 (58.3%) developed symptoms after hospitalisation; 89 cases (53.0%) developed symptoms more than 48 hours after admission. Furthermore, 27 of the 62 (67.7%) patients who developed symptoms in the community ad been hospitalised within the last 3 months. Thirteen of the 168 (7.7%) cases identified had severe disease, resulting in admission to the Intensive Care Unit or death within 30 days of the onset of symptoms. The 3 most common ribotypes isolated were UK 002 (22.9%), UK 014 (13.3%) and the binary toxin-positive ribotype UK 244 (8.4%). The only other binary toxin positive ribotype isolated was UK 078 (n = 1). Of concern was the detection of the binary toxin positive ribotype UK 244, which has recently been described in other parts of Australia and New Zealand. No isolates were of the international epidemic clone of ribotype UK 027, although ribotype UK 244 is genetically related to this clone. Further studies are required to track the epidemiology of ribotype UK 244 in Australia and New Zealand.
authors: University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland.
authors: Charlotte A
authors: CA
authors: Huber
authors: Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, Queensland and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland.
authors: Lisa
authors: L
authors: Hall
authors: School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia.
authors: Nikki F
authors: NF
authors: Foster
authors: Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, Queensland.
authors: Mareeka
authors: M
authors: Gray
authors: Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, Queensland and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland.
authors: Michelle
authors: M
authors: Allen
authors: University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland.
authors: Leisha J
authors: LJ
authors: Richardson
authors: Sullivan Nicolaides Pathology, Brisbane, Queensland.
authors: Jennifer
authors: J
authors: Robson
authors: Queensland Medical Laboratories, Brisbane, Queensland.
authors: Renu
authors: R
authors: Vohra
authors: Mater Pathology, Brisbane, Queensland and University of Queensland, Brisbane, Queensland.
authors: Sanmarie
authors: S
authors: Schlebusch
authors: Central Microbiology Laboratory, Pathology Queensland, Brisbane, Queensland.
authors: Narelle
authors: N
authors: George
authors: Central Microbiology Laboratory, Pathology Queensland, Brisbane, Queensland.
authors: Graeme R
authors: GR
authors: Nimmo
authors: School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia and PathWest Laboratory Medicine WA, Nedlands, Western Australia.
authors: Thomas V
authors: TV
authors: Riley
authors: University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland and Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Brisbane, Queensland and Central Microbiology Laboratory, Pathology Queensland, Brisbane, Queensland.
authors: David L
authors: DL
authors: Paterson
mesh_terms: D036002:ADP Ribose Transferases / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000235:genetics* / Q000254:growth & development / Q000472:pathogenicity; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D062665:Epidemiological Monitoring; D005798:Genes, Bacterial; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D021521:Ribotyping; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D001426:Bacterial Proteins; D036002:ADP Ribose Transferases; C410164:actin-specific ADP-ribosyltransferase, Clostridium