3 years ago

An outbreak of Clostridium difficile infections due to a new PCR ribotype 826: epidemiological and microbiological analyses

The aim was to investigate an unusual outbreak of 5 patients with in total 8 episodes of a Clostridium difficile infection (CDI) on a gastro intestinal surgical ward of a Dutch tertiary care university affiliated hospital. Methods Clinical case investigations and laboratory analyses were performed. Laboratory analyses included PCR ribotyping, MLVA typing, toxinotyping, antimicrobial susceptibility testing and whole genome sequencing. Results The outbreak was associated with recurrent and severe disease in 2 out of 5 patients. All episodes were due to a unique ribotype that was not recognized in the collection of an international network of reference laboratories and was assigned PCR ribotype 826. PCR ribotype 826 is a toxin A, toxin B and binary toxin positive ribotype which according to molecular typing belongs to clade 5 and resembles the so called “hypervirulent “ ribotype 078. The presence of a clonal outbreak was confirmed by whole genome sequencing, yet the source of this newly identified ribotype remained unclear. Conclusion This newly identified C. difficile PCR ribotype 826 is part of clade 5 and might as well have increased virulence. The recognition of this outbreak highlights the need of ongoing CDI surveillance to monitor new circulating ribotypes with assumed increased virulence.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304603

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