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Possible Interplay Between Hospital and Community Transmission of a Novel Clostridium Difficile Sequence Type 295 Recognized by Next-Generation Sequencing

Published online by Cambridge University Press:  14 April 2016

Geraldine Moloney ,
Micheál Mac Aogáin ,
Maureen Kelleghan ,
Brian O’Connell ,
Caroline Hurley ,
Elizabeth Montague ,
Mary Conlon ,
Helena Murray  and
Thomas R. Rogers
Geraldine Moloney*
Affiliation:
Department of Clinical Microbiology, Trinity College Dublin, St James’s Hospital, Dublin, Ireland
Micheál Mac Aogáin
Affiliation:
Department of Clinical Microbiology, Trinity College Dublin, St James’s Hospital, Dublin, Ireland
Maureen Kelleghan
Affiliation:
Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland
Brian O’Connell
Affiliation:
Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland
Caroline Hurley
Affiliation:
Department of Public Health, Health Service Executive, Dr Steevens’ Hospital, Dublin, Ireland
Elizabeth Montague
Affiliation:
Department of Public Health, Health Service Executive, Dr Steevens’ Hospital, Dublin, Ireland
Mary Conlon
Affiliation:
Department of Public Health, Health Service Executive, Dr Steevens’ Hospital, Dublin, Ireland
Helena Murray
Affiliation:
Department of Public Health, Health Service Executive, Dr Steevens’ Hospital, Dublin, Ireland
Thomas R. Rogers
Affiliation:
Department of Clinical Microbiology, Trinity College Dublin, St James’s Hospital, Dublin, Ireland Department of Clinical Microbiology, St James’s Hospital, Dublin, Ireland
*
Address correspondence to Geraldine Moloney, Department of Clinical Microbiology, Sir Patrick Dun Translational Research Laboratory, Trinity College Dublin, St James’s Hospital, Dublin, Ireland.
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Abstract

OBJECTIVE

To use next-generation sequencing (NGS) analysis to enhance epidemiological information to identify and resolve a Clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of current standard PCR ribotyping.

METHODS

NGS analysis was performed as part of prospective surveillance of all detected C. difficile isolates at a university hospital. An outbreak of a novel C. difficile sequence type (ST)-295 was identified in a hospital and a community hostel for homeless adults. Phylogenetic analysis was performed of all ST-295 and closest ST-2 isolates. Epidemiological details were obtained from hospital records and the public health review of the community hostel.

RESULTS

We identified 7 patients with C. difficile ST-295 infections between June 2013 and April 2015. Of these patients, 3 had nosocomial exposure to this infection and 3 had possible hostel exposure. Current Society for Healthcare Epidemiology of America (SHEA)— Infectious Diseases Society of America (IDSA) surveillance definitions (2010) were considered in light of our NGS findings. The initial transmission was not detectable using current criteria, because of 16 weeks between ST-295 exposure and symptoms. We included 3 patients with hostel exposure who met surveillance criteria of hospital-acquired infection due to their hospital admissions.

CONCLUSION

NGS analysis enhanced epidemiological information and helped identify and resolve an outbreak beyond the capacity of standard PCR ribotyping. In this cluster of cases, NGS was used to identify a hostel as the likely source of community-based C. difficile transmission.

Infect Control Hosp Epidemiol 2016;37:680–684

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 6 , June 2016 , pp. 680 - 684
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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