Clostridium difficile 027 infection in Central Italy
<p>Abstract</p> <p>Background</p> <p><it>Clostridium difficile</it> (CD) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. The upsurge in incidence of CD coincided with the emer...
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| Format: | Article |
| Language: | English |
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BMC
2012-12-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.biomedcentral.com/1471-2334/12/370 |
| _version_ | 1811286207748898816 |
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| author | Di Bella Stefano Paglia Maria Grazia Johnson Emma Petrosillo Nicola |
| author_facet | Di Bella Stefano Paglia Maria Grazia Johnson Emma Petrosillo Nicola |
| author_sort | Di Bella Stefano |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p><it>Clostridium difficile</it> (CD) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. The upsurge in incidence of CD coincided with the emergence of a hypervirulent strain of CD characterized as 027.</p> <p>In 2010, 8 cases of CD 027 infections were identified in Italy. Since then, no further reports have been published. We describe 10 new cases of CD 027 infection occurring in Italy.</p> <p>Methods</p> <p>Since December 2010, stool samples of patients with severe diarrhea and clinical suspicion of the presence of a hypervirulent strain, were tested for CD 027 by the Xpert <it>C. difficile</it> PCR assay (Cepheid, Sunnyvale, CA). Clinical, epidemiological and laboratory data were collected.</p> <p>Results</p> <p>From December 2010 to April 2012, 24 faecal samples from 19 patients who fit the above criteria were submitted to our laboratory. Samples were collected from 7 different hospitals.</p> <p>Of these, 17 had a positive PCR for CD and 10 were the epidemic 027 strain (59%). All PCR positive samples had a positive EIA toxin A/B test. Nine of 10 patients were recently exposed to antimicrobials and were healthcare-associated, including 4 with a history of long term care facility (LTCF) admission; the remaining case was community-associated, namely the wife of a patient with hospital-acquired CD 027 infection. Five patients experienced at least one recurrence of CD associated diarrhea (CDAD) with a total of 12 relapsing episodes. Of these, two patients had 5 and 6 relapses respectively.</p> <p>We compared the 10 patients with 027 CDAD versus the 7 patients with non-027 CDAD. None of the 7 patients with non-027 CDAD had a recent history of LTCF admission and no subsequent relapses were observed (p = 0.04).</p> <p>Conclusions</p> <p>Our study shows that CD 027 is emerging in healthcare facilities in Italy. Whilst nosocomial acquisition accounted for the majority of such cases, 4 patients had history of a recent stay in a LTCF. We highlight the substantial risks of this highly transmissible organism in such environments. Moreover, 50% of our patients with CDAD from the 027 strain had high relapse rates which may serve to further establish this strain within the Italian health and social care systems.</p> |
| first_indexed | 2024-04-13T02:56:20Z |
| format | Article |
| id | doaj.art-c6f7c3404a5144a18c3e9c86710c560a |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-13T02:56:20Z |
| publishDate | 2012-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-c6f7c3404a5144a18c3e9c86710c560a2022-12-22T03:05:39ZengBMCBMC Infectious Diseases1471-23342012-12-0112137010.1186/1471-2334-12-370Clostridium difficile 027 infection in Central ItalyDi Bella StefanoPaglia Maria GraziaJohnson EmmaPetrosillo Nicola<p>Abstract</p> <p>Background</p> <p><it>Clostridium difficile</it> (CD) has increasingly become recognised as a significant international health burden, often associated with the healthcare environment. The upsurge in incidence of CD coincided with the emergence of a hypervirulent strain of CD characterized as 027.</p> <p>In 2010, 8 cases of CD 027 infections were identified in Italy. Since then, no further reports have been published. We describe 10 new cases of CD 027 infection occurring in Italy.</p> <p>Methods</p> <p>Since December 2010, stool samples of patients with severe diarrhea and clinical suspicion of the presence of a hypervirulent strain, were tested for CD 027 by the Xpert <it>C. difficile</it> PCR assay (Cepheid, Sunnyvale, CA). Clinical, epidemiological and laboratory data were collected.</p> <p>Results</p> <p>From December 2010 to April 2012, 24 faecal samples from 19 patients who fit the above criteria were submitted to our laboratory. Samples were collected from 7 different hospitals.</p> <p>Of these, 17 had a positive PCR for CD and 10 were the epidemic 027 strain (59%). All PCR positive samples had a positive EIA toxin A/B test. Nine of 10 patients were recently exposed to antimicrobials and were healthcare-associated, including 4 with a history of long term care facility (LTCF) admission; the remaining case was community-associated, namely the wife of a patient with hospital-acquired CD 027 infection. Five patients experienced at least one recurrence of CD associated diarrhea (CDAD) with a total of 12 relapsing episodes. Of these, two patients had 5 and 6 relapses respectively.</p> <p>We compared the 10 patients with 027 CDAD versus the 7 patients with non-027 CDAD. None of the 7 patients with non-027 CDAD had a recent history of LTCF admission and no subsequent relapses were observed (p = 0.04).</p> <p>Conclusions</p> <p>Our study shows that CD 027 is emerging in healthcare facilities in Italy. Whilst nosocomial acquisition accounted for the majority of such cases, 4 patients had history of a recent stay in a LTCF. We highlight the substantial risks of this highly transmissible organism in such environments. Moreover, 50% of our patients with CDAD from the 027 strain had high relapse rates which may serve to further establish this strain within the Italian health and social care systems.</p>http://www.biomedcentral.com/1471-2334/12/370<it>Clostridium difficile</it>CDADNAP1027Italy |
| spellingShingle | Di Bella Stefano Paglia Maria Grazia Johnson Emma Petrosillo Nicola Clostridium difficile 027 infection in Central Italy BMC Infectious Diseases <it>Clostridium difficile</it> CDAD NAP1 027 Italy |
| title | Clostridium difficile 027 infection in Central Italy |
| title_full | Clostridium difficile 027 infection in Central Italy |
| title_fullStr | Clostridium difficile 027 infection in Central Italy |
| title_full_unstemmed | Clostridium difficile 027 infection in Central Italy |
| title_short | Clostridium difficile 027 infection in Central Italy |
| title_sort | clostridium difficile 027 infection in central italy |
| topic | <it>Clostridium difficile</it> CDAD NAP1 027 Italy |
| url | http://www.biomedcentral.com/1471-2334/12/370 |
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