title: A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility.
abstract: OBJECTIVE To describe and analyze a large outbreak of Clostridium difficile 027 (CD-027) infections. METHODS Confirmed CD-027 cases were defined as CD infection plus real-time polymerase chain reaction assay (PCR) positive for CD-027. Clinical and microbiological data on patients with CD-027 infection were collected from January 2013 to December 2015 in the Provence-Alpes-Côte-d'Azur region (southeastern France). RESULTS In total, 19 healthcare facilities reported 144 CD-027 infections (112 confirmed and 32 probable CD-027 infections) during a 22-month period outbreak. Although the incidence rate per 10,000 bed days was lower in long-term care facilities (LTCFs) than in acute care facilities (0.05 vs 0.14; P<.001), cases occurred mainly in LTCFs, one of which was the probable source of this outbreak. After centralization of CD testing, the rate of confirmed CD-027 cases from LTCFs or residential-care homes increased significantly (69% vs 92%; P<.001). Regarding confirmed CD-027 patients, the sex ratio and the median age were 0.53 and 84.2 years, respectively. The 30-day crude mortality rate was 31%. Most patients (96%) had received antibiotics within 3 months prior to the CD colitis diagnosis. During the study period, the rate of patients with CD-027 (compared with all patients tested in the point-of-care laboratories) decreased significantly (P=.03). CONCLUSIONS A large CD-027 outbreak occurred in southeastern France as a consequence of an initial cluster of cases in a single LTCF. Successful interventions included rapid isolation and testing of residents with potentially infectious diarrhea and cohorting of case patients in a specialized infectious diseases ward to optimize management. Infect Control Hosp Epidemiol 2016;1-5.
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Nadim
authors.initials: N
authors.lastname: Cassir
authors.affiliation: 3L'Antenne Régionale de Lutte contre les Infections Nosocomiales de la région en PACA,CCLIN,Marseille,France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Delarozière
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dubourg
authors.affiliation: 2Institut Hospitalo-Universitaire Méditerranée Infection,Assistance Publique Hôpitaux de Marseille,Centre Hospitalier Universitaire Nord,Marseille,France.
authors.forename: Marion
authors.initials: M
authors.lastname: Delord
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lagier
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Brouqui
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Florence
authors.initials: F
authors.lastname: Fenollar
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.affiliation: 1Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes,UMR CNRS-7278,IRD189,INSERM U1095,Méditerranée-Infection,Aix-Marseille-Université,Marseille,France.
authors.forename: Pierre Edouard
authors.initials: PE
authors.lastname: Fournier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D008134:Long-Term Care; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D062211:Spatio-Temporal Analysis; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents