title: Clostridium difficile outbreak caused by NAP1/BI/027 strain and non-027 strains in a Mexican hospital.
abstract: BACKGROUND
  Clostridium difficile infections caused by the NAP1/B1/027 strain are more severe, difficult to treat, and frequently associated with relapses.
  
  
  METHODS
  A case-control study was designed to examine a C. difficile infection (CDI) outbreak over a 12-month period in a Mexican hospital. The diagnosis of toxigenic CDI was confirmed by real-time polymerase chain reaction, PCR (Cepheid Xpert C. difficile/Epi).
  
  
  RESULTS
  During the study period, 288 adult patients were evaluated and 79 (27.4%) patients had confirmed CDI (PCR positive). C. difficile strain NAP1/B1/027 was identified in 31 (39%) of the patients with confirmed CDI (240 controls were included). Significant risk factors for CDI included any underlying disease (p<0.001), prior hospitalization (p<0.001), and antibiotic (p<0.050) or steroid (p<0.001) use. Laboratory abnormalities included leukocytosis (p<0.001) and low serum albumin levels (p<0.002). Attributable mortality was 5%. Relapses occurred in 10% of patients. Risk factors for C. difficile NAP1/B1/027 strain infections included prior use of quinolones (p<0.03). Risk factors for CDI caused by non-027 strains included chronic cardiac disease (p<0.05), chronic renal disease (p<0.009), and elevated serum creatinine levels (p<0.003). Deaths and relapses were most frequent in the 027 group (10% and 19%, respectively).
  
  
  CONCLUSIONS
  C. difficile NAP1/BI/027 strain and non-027 strains are established pathogens in our hospital. Accordingly, surveillance of C. difficile infections is now part of our nosocomial prevention program.
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico. Electronic address: rayomorfin@gmail.com.
authors.forename: Rayo
authors.initials: R
authors.lastname: Morfin-Otero
authors.affiliation: Servicio de Gastroenterología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Mexico; Departamento de Patología Clínica, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Mexico.
authors.forename: Elvira
authors.initials: E
authors.lastname: Garza-Gonzalez
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Aguirre-Diaz
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Escobedo-Sanchez
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico.
authors.forename: Sergio
authors.initials: S
authors.lastname: Esparza-Ahumada
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Perez-Gomez
authors.affiliation: Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico.
authors.forename: Santiago
authors.initials: S
authors.lastname: Petersen-Morfin
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico.
authors.forename: Esteban
authors.initials: E
authors.lastname: Gonzalez-Diaz
authors.affiliation: Departamento de Patología Clínica, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Mexico.
authors.forename: Adrian
authors.initials: A
authors.lastname: Martinez-Melendez
authors.affiliation: Hospital Civil de Guadalajara, Fray Antonio Alcalde, Mexico; Instituto de Patología Infecciosa y Experimental, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodriguez-Noriega
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000145:classification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult
keywords: 027 strain; Clostridium difficile; Mexico; Outbreak