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Clostridium difficile Outbreak Strain BI Is Highly Endemic in Chicago Area Hospitals

Published online by Cambridge University Press:  02 January 2015

Stephanie R. Black ,
Kingsley N. Weaver ,
Roderick C. Jones ,
Kathleen A. Ritger ,
Laurica A. Petrella ,
Susan P. Sambol ,
Michael Vernon ,
Stephanie Burton ,
Sylvia Garcia-Houchins  and
Stephen G. Weber
...Show all authors
Stephanie R. Black*
Affiliation:
Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois
Kingsley N. Weaver
Affiliation:
Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois
Roderick C. Jones
Affiliation:
Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois
Kathleen A. Ritger
Affiliation:
Communicable Disease Program, Chicago Department of Public Health, Chicago, Illinois
Laurica A. Petrella
Affiliation:
Research Service, Edward Hines Jr. Veterans Affairs Hospital and Infectious Disease Division, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Susan P. Sambol
Affiliation:
Research Service, Edward Hines Jr. Veterans Affairs Hospital and Infectious Disease Division, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Michael Vernon
Affiliation:
Communicable Disease Program, Cook County Department of Public Health, Oak Forest, Illinois
Stephanie Burton
Affiliation:
Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
Sylvia Garcia-Houchins
Affiliation:
Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
Stephen G. Weber
Affiliation:
Section of Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
Mary Alice Lavin
Affiliation:
Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Dale Gerding
Affiliation:
Research Service, Edward Hines Jr. Veterans Affairs Hospital and Infectious Disease Division, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Stuart Johnson
Affiliation:
Research Service, Edward Hines Jr. Veterans Affairs Hospital and Infectious Disease Division, Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Susan I. Gerber
Affiliation:
Communicable Disease Program, Cook County Department of Public Health, Oak Forest, Illinois
*
2160 West Ogden Avenue, Chicago, IL 60612 (stephanie.black@cityofchicago.org)
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Abstract

Objective.

Describe the clinical and molecular epidemiology of incident Clostridium difficile infection (CDI) cases in Chicago area acute healthcare facilities (HCFs).

Design and Setting.

Laboratory, clinical, and epidemiologic information was collected for patients with incident CDI who were admitted to acute HCFs in February 2009. Stool cultures and restriction endonuclease analysis typing of the recovered C. difficile isolates was performed.

Patients.

Two hundred sixty-three patients from 25 acute HCFs.

Results.

Acute HCF rates ranged from 2 to 7 patients with CDI per 10,000 patient-days. The crude mortality rate was 8%, with 20 deaths occurring in patients with CDI. Forty-two (16%) patients had complications from CDI, including 4 patients who required partial, subtotal, or total colectomy, 3 of whom died. C. difficile was isolated and typed from 129 of 178 available stool specimens. The BI strain was identified in 79 (61%) isolates. Of patients discharged to long-term care who had their isolate typed, 36 (67%) had BI-associated CDI.

Conclusions.

Severe disease was common and crude mortality was substantial among patients with CDI in Chicago area acute HCFs in February 2009. The outbreak-associated BI strain was the predominant endemic strain identified, accounting for nearly two-thirds of cases. Focal HCF outbreaks were not reported, despite the presence of the BI strain. Transfer of patients between acute and long-term HCFs may have contributed to the high incidence of BI cases in this investigation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 9 , September 2011 , pp. 897 - 902
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.Google Scholar
2.Miller, MA, Hyland, M, Ofner-Agostini, , et al.Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhea in Canadian hospitals. Infect Control Hosp Epidemiol 2002;23:137–140.Google Scholar
3.Miller, MA, Gravel, D, Mulvey, M, et al.Surveillance for nosocomial Clostridium difficile associated diarrhea (N-CDAD) within acute-care hospitals in Canada: results of the 2005 nosocomial infections surveillance program (CNISP) study shows escalating mortality. In: Proceedings of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; March 18-21, 2006; Chicago, IL.Google Scholar
4.Muto, CA, Pokrywka, M, Shutt, K, et al.A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280.CrossRefGoogle Scholar
5.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
6.Pepin, J, Valiquette, L, Alary, ME, et al.Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.Google Scholar
7.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.Google Scholar
8.Illinois Department of Public Health. Illinois hospital report card and consumer guide to health care: Clostridium difficile (C. difficile) in Illinois, http://www.healthcarereportcard.illinois.gov/contents/view/C.difficile.Google Scholar
9.McDonald, LC, Coignard, B, Dubberke, E, et al.Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
10.Wilson, KH, Kennedy, MJ, Fekety, FR. Use of sodium taurocholate to enhance spore recovery on a medium selective for Clostridium diffidle. J Clin Microbiol 1982;15:443–446.Google Scholar
11.Clabots, CR, Gerding, SJ, Olson, MM, Peterson, LR, Gerding, DN. Detection of asymptomatic Clostridium difficile carriage by an alcohol shock procedure. J Clin Microbiol 1989;27:2386–2387.Google Scholar
12.Clabots, CR, Johnson, S, Bettin, KM, et al.Development of a rapid and efficient restriction endonuclease analysis typing system for Clostridium difficile and correlation with other typing systems. J Clin Miaobiol 1993;31:1870–1875.CrossRefGoogle ScholarPubMed
13.Gravel, D, Miller, M, Simor, A, et al.Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian nosocomial infection surveillance program study. Clin Infect Dis 2009;48:568–576.Google Scholar
14.Miller, M, Gravel, D, Mulvey, M, et al.Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis 2010;50:194–201.CrossRefGoogle ScholarPubMed
15.O'Connor, JR, Johnson, S, Gerding, DN. Clostridium difficile infection caused by the epidemic BI/NAP1/027 strain. Gastroenterology. 2009;136:1913–1924.CrossRefGoogle ScholarPubMed
16.Hubert, B, Loo, VG, Bourgault, AM, et al.A portrait of the geographic dissemination of the Clostridium difficile North American pulsed-field type 1 strain and the epidemiology of C. difficile-associated disease in Quebec. Clin Infect Dis 2007;44:238–244.CrossRefGoogle ScholarPubMed
17.Goldstein, EJC, Polonsky, J, Touzani, M, Citron, DM. C. difficile infection (CDI) in a long-term acute care facility (LTAC). Anaerobe 2009;15:241–243.CrossRefGoogle Scholar
18.Angulo, F, Sharapov, U, Long, C, et al.An epidemie hospital strain as a cause of community-associated Clostridium difficile-associated disease: FoodNet pilot study, 2006. Poster presented as part of the Second International Clostridium difficile Symposium; June 6-9, 2007; Maribor.Google Scholar
19.Cheknis, AK, Sambol, SP, Davidson, DM, et al.Distribution of Clostridium difficile strains from North America, European and Australian trial of treatment for C. difficile infections: 2005-2007. Anaerobe 2009;15:230–233.Google Scholar
20.Louie, T, Gerson, M, Grimard, D, et al.Results of a phase III trial comparing tolevamer, vancomycin and metronidazole in patients with Clostridium difficile-associated diarrhea (CDAD). In: Proceedings of the 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; 2007; Chicago. Abstract K-425a.Google Scholar
21.Zar, FA, Bakkanagari, SR, Moorthi, KM, Davis, MB. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302–307.Google Scholar
22.Dubberke, ER, Butler, AM, Reske, KA, et al.Attributable outcomes of endemic Clostridium difficile-associated disease in nonsurgical patients. Emerg Infect Dis 2008;14:1031–1038.Google Scholar
23.Huang, SS, Avery, TR, Song, Y, et al.Quantifying interhospital patient sharing as a mechanism for infectious disease spread. Infect Control Hosp Epidemiol 2010;31:1160–1169.Google Scholar
24.Kazakova, SV, Ware, K, Baughman, B, et al.A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile. Arch Intern Med 2006;166:2518–2524.Google Scholar
25.Campbell, RJ, Giljahn, L, Machesky, K, et al.Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30:526–533.CrossRefGoogle ScholarPubMed
26.Johnson, S, Schriever, C, Galang, M, Kelly, CP, Gerding, DN. Interruption of recurrent Clostridium difficile-associated diarrhea episodes by serial therapy with vancomycin and rifaximin. Clin Infect Dis 2007;44:846–848.CrossRefGoogle ScholarPubMed