Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-27T04:31:32.179Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  26 September 2018

Bradley T. Endres ,
Kierra M. Dotson ,
Kelley Poblete ,
Jacob McPherson ,
Chris Lancaster ,
Eugénie Bassères ,
Ali Memariani ,
Sandi Arnold ,
Shawn Tupy  and
Conner Carlsen
...Show all authors
Bradley T. Endres
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Kierra M. Dotson
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Kelley Poblete
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Jacob McPherson
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Chris Lancaster
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Eugénie Bassères
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Ali Memariani
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Sandi Arnold
Affiliation:
Texas Department of State Health Services, AustinTexas
Shawn Tupy
Affiliation:
Texas Department of State Health Services, AustinTexas
Conner Carlsen
Affiliation:
Texas Department of State Health Services, AustinTexas
Bonnie Morehead
Affiliation:
Texas Department of State Health Services, AustinTexas
Sophia Anyatonwu
Affiliation:
Texas Department of State Health Services, AustinTexas
Christa Cook
Affiliation:
Texas Department of State Health Services, AustinTexas
Khurshida Begum
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
M. Jahangir Alam
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Kevin W. Garey*
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1322 - 1329
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.Google Scholar
2. Alam, MJ, Walk, ST, Endres, BT, et al. Community environmental contamination of toxigenic Clostridium difficile . Open Forum Infect Dis 2017;4:ofx018.Google Scholar
3. Chopra, T, Goldstein, EJ. Clostridium difficile infection in long-term care facilities: a call to action for antimicrobial stewardship. Clin Infect Dis 2015;60 Suppl 2:S72–S76.Google Scholar
4. Curry, SR, Muto, CA, Schlackman, JL, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis 2013;57:1094–1102.Google Scholar
5. Ziakas, PD, Joyce, N, Zacharioudakis, IM, et al. Prevalence and impact of Clostridium difficile infection in elderly residents of long-term care facilities, 2011: a nationwide study. Medicine (Baltimore) 2016;95:e4187.Google Scholar
6. Wust, J, Sullivan, NM, Hardegger, U, Wilkins, TD. Investigation of an outbreak of antibiotic-associated colitis by various typing methods. J Clin Microbiol 1982;16:1096–1101.Google Scholar
7. Lemee, L, Dhalluin, A, Testelin, S, et al. Multiplex PCR targeting TPI (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile . J Clin Microbiol 2004;42:5710–5714.Google Scholar
8. Martinson, JN, Broadaway, S, Lohman, E, et al. Evaluation of portability and cost of a fluorescent PCR ribotyping protocol for Clostridium difficile epidemiology. J Clin Microbiol 2015;53:1192–1197.Google Scholar
9. Alam, MJ, Anu, A, Walk, ST, Garey, KW. Investigation of potentially pathogenic Clostridium difficile contamination in household environs. Anaerobe 2014;27:31–33.Google Scholar
10. Bidet, P, Barbut, F, Lalande, V, Burghoffer, B, Petit, JC. Development of a new PCR-ribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing. FEMS Microbiol Lett 1999;175:261–266.Google Scholar
11. van den Berg, RJ, Kuijper, EJ, van Coppenraet, LE, Claas, EC. Rapid diagnosis of toxinogenic Clostridium difficile in faecal samples with internally controlled real-time PCR. Clin Microbiol Infect 2006;12:184–186.Google Scholar
12. Broukhanski, G, Low, DE, Pillai, DR. Modified multiple-locus variable-number tandem-repeat analysis for rapid identification and typing of Clostridium difficile during institutional outbreaks. J Clin Microbiol 2011;49:1983–1986.Google Scholar
13. Broukhanski, G, Simor, A, Pillai, DR. Defining criteria to interpret multilocus variable-number tandem repeat analysis to aid Clostridium difficile outbreak investigation. J Med Microbiol 2011;60:1095–1100.Google Scholar
14. Langmead, B, Salzberg, SL. Fast gapped-read alignment with Bowtie 2. Nat Methods 2012;9:357–359.Google Scholar
15. Li, H, Handsaker, B, Wysoker, A, et al. The sequence alignment/map format and SAMtools. Bioinformatics 2009;25:2078–2079.Google Scholar
16. Kumar, N, Miyajima, F, He, M, et al. Genome-based infection tracking reveals dynamics of Clostridium difficile transmission and disease recurrence. Clin Infect Dis 2016;62:746–752.Google Scholar
17. Gupta, SK, Padmanabhan, BR, Diene, SM, et al. ARG-ANNOT, a new bioinformatic tool to discover antibiotic resistance genes in bacterial genomes. Antimicrob Agents Chemother 2014;58:212–220.Google Scholar
18. He, M, Miyajima, F, Roberts, P, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile . Nat Genet 2013;45:109–113.Google Scholar
19. 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
20. Guerrero, DM, Nerandzic, MM, Jury, LA, Chang, S, Jump, RL, Donskey, CJ. Clostridium difficile infection in a Department of Veterans Affairs long-term care facility. Infect Control Hosp Epidemiol 2011;32:513–515.Google Scholar
21. Archbald-Pannone, LR, Boone, JH, Carman, RJ, Lyerly, DM, Guerrant, RL. Clostridium difficile ribotype 027 is most prevalent among inpatients admitted from long-term care facilities. J Hosp Infect 2014;88:218–221.Google Scholar
22. Yui, S, Ali, S, Muzslay, M, Jeanes, A, Wilson, APR. Identification of Clostridium difficile reservoirs in the patient environment and efficacy of aerial hydrogen peroxide decontamination. Infect Control Hosp Epidemiol 2017;38:1487–1492.Google Scholar