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Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

  • Bradley T. Endres (a1), Kierra M. Dotson (a1), Kelley Poblete (a1), Jacob McPherson (a1), Chris Lancaster (a1), Eugénie Bassères (a1), Ali Memariani (a1), Sandi Arnold (a2), Shawn Tupy (a2), Conner Carlsen (a2), Bonnie Morehead (a2), Sophia Anyatonwu (a2), Christa Cook (a2), Khurshida Begum (a1), M. Jahangir Alam (a1) and Kevin W. Garey (a1)...

Abstract

Objective

This article describes a CDI outbreak in a long-term care (LTC) facility that used molecular typing techniques and whole-genome sequencing to identify widespread dissemination of the clonal strain in the environment which was successfully removed after terminal cleaning.

Setting

This study was conducted in a long-term care facility in Texas.

Methods

A recently hospitalized LTC patient was diagnosed with CDI followed shortly thereafter by 7 subsequent CDI cases. A stool specimen was obtained from each patient for culturing and typing. An environmental point-prevalence study of the facility was conducted before and after terminal cleaning of the facility to assess environmental contamination. Cultured isolates were typed using ribotyping, multilocus variant analysis, and whole-genome sequencing.

Results

Stool samples were available for 5 of 8 patients; of these specimens, 4 grew toxigenic C. difficile ribotype 027. Of 50 environmental swab samples collected throughout the facility prior to the facility-wide terminal cleaning, 19 (38%) grew toxigenic C. difficile (most commonly ribotype 027, 79%). The terminal cleaning was effective at reducing C. difficile spores in the environment and at eradicating the ribotype 027 strain (P<.001). Using multilocus variance analysis and whole-genome sequencing, clinical and environmental strains were highly related and, in some cases, were identical.

Conclusion

Using molecular typing techniques, we demonstrated reduced environmental contamination with toxigenic C. difficile and the eradication of a ribotype 027 clone. These techniques may help direct infection control efforts and decrease the burden of CDI in the healthcare system.

Copyright

Corresponding author

Author for correspondence: Kevin W. Garey PharmD, MS, University of Houston College of Pharmacy, 4849 Calhoun Road, Houston, TX 77204. E-mail: kgarey@uh.edu

References

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Environmental transmission of Clostridioides difficile ribotype 027 at a long-term care facility; an outbreak investigation guided by whole genome sequencing

  • Bradley T. Endres (a1), Kierra M. Dotson (a1), Kelley Poblete (a1), Jacob McPherson (a1), Chris Lancaster (a1), Eugénie Bassères (a1), Ali Memariani (a1), Sandi Arnold (a2), Shawn Tupy (a2), Conner Carlsen (a2), Bonnie Morehead (a2), Sophia Anyatonwu (a2), Christa Cook (a2), Khurshida Begum (a1), M. Jahangir Alam (a1) and Kevin W. Garey (a1)...

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