ena-STUDY-LUMC-27-02-2020-08:50:58:654-735
An outbreak of Clostridioides difficile infections due to a 027-like PCR ribotype 181 in a Greek rehabilitation clinic.
Clostridioides difficile is one of the most important healthcare-associated pathogens.    A decade ago, the so-alled “ hypervirulent”  PCR ribotype 027 caused large outbreaks worldwide. Recently, a number of new 027-like types have been found that all belong to the multilocus sequence typing (MLST) Clade 2. We identified a rapidly spreading outbreak of C. difficile infections (CDI) at orthopedic and neurological wards in a Greek 180-bed Rehabilitation Clinic (RC) within a 28-day time-period in 2019. The CDI incidence rate on the RC  quadrupled to 49 infections per 10,000 patient days. All patients had been previously hospitalized in 7 different hospitals, suffered from co-morbidities and received antibiotic therapy within three months before the C. difficile episode. The outbreak strain was identified as PCR ribotype (RT) 181, belonged to sequence type (ST) 1 and had a 18bp deletion in tcdC at position 311 together with a single nucleotide deletion at position 117, similarly to RT 027. The outbreak was associated with mild to moderate disease and only 6% of the patients developed a relapse. We conclude that new C. difficile ribotypes still emerge and that C. difficile RT 181 was rapidly spreading but not associated with increased mortality and higher relapse rates.
Clostridioides difficile is one of the most important healthcare-associated pathogens.    A decade ago, the so-alled “ hypervirulent”  PCR ribotype 027 caused large outbreaks worldwide. Recently, a number of new 027-like types have been found that all belong to the multilocus sequence typing (MLST) Clade 2. We identified a rapidly spreading outbreak of C. difficile infections (CDI) at orthopedic and neurological wards in a Greek 180-bed Rehabilitation Clinic (RC) within a 28-day time-period in 2019. The CDI incidence rate on the RC  quadrupled to 49 infections per 10,000 patient days. All patients had been previously hospitalized in 7 different hospitals, suffered from co-morbidities and received antibiotic therapy within three months before the C. difficile episode. The outbreak strain was identified as PCR ribotype (RT) 181, belonged to sequence type (ST) 1 and had a 18bp deletion in tcdC at position 311 together with a single nucleotide deletion at position 117, similarly to RT 027. The outbreak was associated with mild to moderate disease and only 6% of the patients developed a relapse. We conclude that new C. difficile ribotypes still emerge and that C. difficile RT 181 was rapidly spreading but not associated with increased mortality and higher relapse rates.