1887
  1. Home
  2. Eurosurveillance
  3. Volume 21, Issue 29, 21/Jul/2016
  4. Article
Surveillance and outbreak report Open Access
Like 0
Download

Abstract

There are limited national epidemiological data for community-associated (CA)- infections (CDIs). Between March 2011 and March 2013, laboratories in England submitted to the Ribotyping Network (CDRN) up to 10 diarrhoeal faecal samples from successive patients with CA-CDI, defined here as toxin-positive diarrhoea commencing outside hospital (or less than 48 hours after hospital admission), including those cases associated with community-based residential care, with no discharge from hospital within the previous 12 weeks. Patient demographics and PCR ribotypes were compared for CA-CDIs in our study and presumed healthcare-associated (HA) CDIs via CDRN. Ribotype diversity indices, ranking and relative prevalences were very similar in CA- vs HA-CDIs, although ribotypes 002 (p ≤ 0.0001),020 (p = 0.009) and 056 (p < 0.0001) predominated in CA-CDIs; ribotype 027 (p = 0.01) predominated in HA-CDIs. Epidemic ribotypes 027 and 078 predominated in institutional residents with CDI (including care/nursing homes) compared with people with CDI living at home. Ribotype diversity decreased with increasing age in HA-CDIs, but not in CA-CDIs. Ribotype 078 CA-CDIs were significantly more common in elderly people (3.4% (6/174) vs 8.7% (45/519) in those aged < 65 and ≥ 65 years, respectively; p = 0.019). No antibiotics were prescribed in the previous four weeks in about twofold more CA-CDI vs HAs (38.6% (129/334) vs 20.3% (1,226/6,028); p < 0.0001). We found very similar ribotype distributions in CA- and HA-CDIs, although a few ribotypes significantly predominated in one setting. These national data emphasise the close interplay between, and likely common reservoirs for, CDIs, particularly when epidemic strains are not dominant.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2016.21.29.30295
2016-07-21
2024-11-13
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.29.30295
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/21/29/eurosurv-21-30295-6.html?itemId=/content/10.2807/1560-7917.ES.2016.21.29.30295&mimeType=html&fmt=ahah

References

  1. Freeman J, Bauer MP, Baines SD, Corver J, Fawley WN, Goorhuis B, et al. The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev. 2010;23(3):529-49.  https://doi.org/10.1128/CMR.00082-09  PMID: 20610822 
  2. Gupta A, Khanna S. Community-acquired Clostridium difficile infection: an increasing public health threat. Infect Drug Resist. 2014;7(7):63-72. PMID: 24669194 
  3. Lessa FC, Mu Y, Winston LG, Dumyati GK, Farley MM, Beldavs ZG, et al. Determinants of Clostridium difficile Infection Incidence Across Diverse United States Geographic Locations. Open Forum Infect Dis. 2014;1(2):ofu048.  https://doi.org/10.1093/ofid/ofu048  PMID: 25734120 
  4. Chitnis AS, Holzbauer SM, Belflower RM, Winston LG, Bamberg WM, Lyons C, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med. 2013;173(14):1359-67.  https://doi.org/10.1001/jamainternmed.2013.7056  PMID: 23780507 
  5. Hensgens MP, Dekkers OM, Demeulemeester A, Buiting AG, Bloembergen P, van Benthem BH, et al. Diarrhoea in general practice: when should a Clostridium difficile infection be considered? Results of a nested case-control study. Clin Microbiol Infect. 2014;20(12):O1067-74.  https://doi.org/10.1111/1469-0691.12758  PMID: 25040463 
  6. Wheeler JG, Sethi D, Cowden JM, Wall PG, Rodrigues LC, Tompkins DS, et al. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. BMJ. 1999;318(7190):1046-50.  https://doi.org/10.1136/bmj.318.7190.1046  PMID: 10205103 
  7. Tam CC, Rodrigues LC, Viviani L, Dodds JP, Evans MR, Hunter PR, et al. Longitudinal study of infectious intestinal disease in the UK (IID2 study): incidence in the community and presenting to general practice. Gut. 2012;61(1):69-77.  https://doi.org/10.1136/gut.2011.238386  PMID: 21708822 
  8. Public Health England (PHE). CDI mandatory surveillance. London: PHE. [Accessed 24 Aug 2015]. Available from: https://www.gov.uk/government/statistics/mrsa-mssa-and-e-coli-bacteraemia-and-c-difficile-infection-quarterly-epidemiological-commentary
  9. Public Health England (PHE). Clostridium difficile Ribotyping Network for England and Northern Ireland. Biennial report (2013-2015). London: PHE; 2016. Lasted accessed 24 August 2015.
  10. McDonald LC, Coignard B, Dubberke E, Song X, Horan T, Kutty PKAd Hoc Clostridium difficile Surveillance Working Group. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol. 2007;28(2):140-5.  https://doi.org/10.1086/511798  PMID: 17265394 
  11. Kuijper EJ, Coignard B, Tüll PESCMID Study Group for Clostridium difficileEU Member StatesEuropean Centre for Disease Prevention and Control. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect. 2006;12(Suppl 6):2-18.  https://doi.org/10.1111/j.1469-0691.2006.01580.x  PMID: 16965399 
  12. Stubbs SL, Brazier JS, O’Neill GL, Duerden BI. PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol. 1999;37(2):461-3. PMID: 9889244 
  13. Wilcox MH, Shetty N, Fawley WN, Shemko M, Coen P, Birtles A, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis. 2012;55(8):1056-63.  https://doi.org/10.1093/cid/cis614  PMID: 22784871 
  14. Brazier JS, Raybould R, Patel B, Duckworth G, Pearson A, Charlett A, et al. Distribution and antimicrobial susceptibility patterns of Clostridium difficile PCR ribotypes in English hospitals, 2007-08. Euro Surveill. 2008;13(41).pii:19000
  15. Eyre DW, Cule ML, Wilson DJ, Griffiths D, Vaughan A, O’Connor L, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med. 2013;369(13):1195-205.  https://doi.org/10.1056/NEJMoa1216064  PMID: 24066741 
  16. Health Protection Agency (HPA). Clostridium difficile infection: How to deal with the problem. London: HPA; 2008. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340851/Clostridium_difficile_infection_how_to_deal_with_the_problem.pdf
  17. Miller M, Gravel D, Mulvey M, Taylor G, Boyd D, Simor A, et al. Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis. 2010;50(2):194-201.  https://doi.org/10.1086/649213  PMID: 20025526 
  18. Walker AS, Eyre DW, Wyllie DH, Dingle KE, Griffiths D, Shine B, et al. Relationship between bacterial strain type, host biomarkers, and mortality in Clostridium difficile infection. Clin Infect Dis. 2013;56(11):1589-600.  https://doi.org/10.1093/cid/cit127  PMID: 23463640 
  19. Karlström O, Fryklund B, Tullus K, Burman LG. A prospective nationwide study of Clostridium difficile-associated diarrhea in Sweden. The Swedish C. difficile Study Group. Clin Infect Dis. 1998;26(1):141-5.  https://doi.org/10.1086/516277  PMID: 9455523 
  20. Norén T, Akerlund T, Bäck E, Sjöberg L, Persson I, Alriksson I, et al. Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county. J Clin Microbiol. 2004;42(8):3635-43.  https://doi.org/10.1128/JCM.42.8.3635-3643.2004  PMID: 15297509 
  21. Goorhuis A, Bakker D, Corver J, Debast SB, Harmanus C, Notermans DW, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clin Infect Dis. 2008;47(9):1162-70.  https://doi.org/10.1086/592257  PMID: 18808358 
  22. Dumyati G, Stevens V, Hannett GE, Thompson AD, Long C, Maccannell D, et al. Community-associated Clostridium difficile infections, Monroe County, New York, USA. Emerg Infect Dis. 2012;18(3):392-400.  https://doi.org/10.3201/eid1803.102023  PMID: 22377231 
  23. Lessa FC, Mu Y, Bamberg WM, Beldavs ZG, Dumyati GK, Dunn JR, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-34.  https://doi.org/10.1056/NEJMoa1408913  PMID: 25714160 
  24. Davies KA, Longshaw CM, Davis GL, Bouza E, Barbut F, Barna Z, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208-19.  https://doi.org/10.1016/S1473-3099(14)70991-0  PMID: 25455988 
  25. United States Centers for Disease Prevention and Control (CDC). Nursing home care. CDC FastStats. Atlanta, GA: CDC. [Accessed 13 Aug 2015]. Available from: http://www.cdc.gov/nchs/fastats/nursing-home-care.htm
  26. United Kingdom Care Quality Commission. Newcastle upon Tyne: Care Quality Commission. [Accessed 13 Aug 2015]. Available from: http://www.cqc.org.uk/search/services/care-homes
  27. Smith P, Sherlaw-Johnson C, Ariti C, Bardsley M. Focus on: Hospital admissions from care homes. London: The Health Foundation; 2015. Available from: http://www.health.org.uk/sites/default/files/QualityWatch_FocusOnHospitalAdmissionsFromCareHomes.pdf
  28. Comas-Herrera A, Wittenberg R, Pickard L. The long road to universalism? Recent developments in the financing of long-term care in England. Soc Policy Adm. 2010;44(4):375-91.  https://doi.org/10.1111/j.1467-9515.2010.00719.x 
  29. Arvand M, Moser V, Schwehn C, Bettge-Weller G, Hensgens MP, Kuijper EJ. High prevalence of Clostridium difficile colonization among nursing home residents in Hesse, Germany. PLoS One. 2012;7(1):e30183.  https://doi.org/10.1371/journal.pone.0030183  PMID: 22253917 
  30. Rodriguez C, Korsak N, Taminiau B, Avesani V, Van Broeck J, Delmée M, et al. Clostridium difficile infection in elderly nursing home residents. Anaerobe. 2014;30:184-7.  https://doi.org/10.1016/j.anaerobe.2014.08.007  PMID: 25152228 
  31. McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320(4):204-10.  https://doi.org/10.1056/NEJM198901263200402  PMID: 2911306 
  32. Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect. 1998;40(1):1-15.  https://doi.org/10.1016/S0195-6701(98)90019-6  PMID: 9777516 
  33. Furuya-Kanamori L, Stone JC, Clark J, McKenzie SJ, Yakob L, Paterson DL, et al. Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2015;36(2):132-41.  https://doi.org/10.1017/ice.2014.39  PMID: 25632995 
  34. Wilcox MH, Mooney L, Bendall R, Settle CD, Fawley WN. A case-control study of community-associated Clostridium difficile infection. J Antimicrob Chemother. 2008;62(2):388-96.  https://doi.org/10.1093/jac/dkn163  PMID: 18434341 
  35. Bauer MP, Goorhuis A, Koster T, Numan-Ruberg SC, Hagen EC, Debast SB, et al. Community-onset Clostridium difficile-associated diarrhoea not associated with antibiotic usage--two case reports with review of the changing epidemiology of Clostridium difficile-associated diarrhoea. Neth J Med. 2008;66(5):207-11. PMID: 18490799 
  36. Kutty PK, Woods CW, Sena AC, Benoit SR, Naggie S, Frederick J, et al. Risk factors for and estimated incidence of community-associated Clostridium difficile infection, North Carolina, USA. Emerg Infect Dis. 2010;16(2):197-204.  https://doi.org/10.3201/eid1602.090953  PMID: 20113547 
  37. Khanna S, Pardi DS, Aronson SL, Kammer PP, Orenstein R, St Sauver JL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2012;107(1):89-95.  https://doi.org/10.1038/ajg.2011.398  PMID: 22108454 
  38. Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA. 2005;294(23):2989-95.  https://doi.org/10.1001/jama.294.23.2989  PMID: 16414946 
  39. Hensgens MP, Keessen EC, Squire MM, Riley TV, Koene MG, de Boer E, et al. Clostridium difficile infection in the community: a zoonotic disease? Clin Microbiol Infect. 2012;18(7):635-45.  https://doi.org/10.1111/j.1469-0691.2012.03853.x  PMID: 22536816 
  40. Janezic S, Zidaric V, Pardon B, Indra A, Kokotovic B, Blanco JL, et al. International Clostridium difficile animal strain collection and large diversity of animal associated strains. BMC Microbiol. 2014;14(1):173.  https://doi.org/10.1186/1471-2180-14-173  PMID: 24972659 
  41. Marsh JW, Tulenko MM, Shutt KA, Thompson AD, Weese JS, Songer JG, et al. Multi-locus variable number tandem repeat analysis for investigation of the genetic association of Clostridium difficile isolates from food, food animals and humans. Anaerobe. 2011;17(4):156-60.  https://doi.org/10.1016/j.anaerobe.2011.05.015  PMID: 21669297 
  42. Cleary P, Patel B, Fawley W, Wilcox M. No association between Clostridium difficile ribotype 078 infection and food, animal or environmental exposures: matched case-case study. 9th Healthcare Infection Society International Conference. 16-18 November 2014; Lyon, France. Abstract available from: https://www.his.org.uk/files/1214/1831/1509/Poster_abstracts_for_HIS_Website_Nov_2014.pdf
  43. Eyre DW, Tracey L, Elliott B, Slimings C, Huntington PG, Stuart RL, et al. Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012. Euro Surveill. 2015;20(10):pii=21059.  https://doi.org/10.2807/1560-7917.ES2015.20.10.21059  PMID: 25788254 
Enhanced surveillance of Clostridium difficile infection occurring outside hospital, England, 2011 to 2013
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Warren+N+Fawley&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fawley Warren N</a>, <a href="/search?value1=Kerrie+A+Davies&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Davies Kerrie A</a>, <a href="/search?value1=Trefor+Morris&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Morris Trefor</a>, <a href="/search?value1=Peter+Parnell&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Parnell Peter</a>, <a href="/search?value1=Robin+Howe&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Howe Robin</a>, <a href="/search?value1=Mark+H+Wilcox&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wilcox Mark H</a>, <a href="/search?value1=on+behalf+of+the+Clostridium+difficile+Ribotyping+Network+%28CDRN%29+Working+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">on behalf of the Clostridium difficile Ribotyping Network (CDRN) Working Group</a></span>. Enhanced surveillance of Clostridium difficile infection occurring outside hospital, England, 2011 to 2013. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(29):pii=30295. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.29.30295" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.29.30295</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 08 Oct 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Mar 2016 </span> </p>
/content/10.2807/1560-7917.ES.2016.21.29.30295
/content/10.2807/1560-7917.ES.2016.21.29.30295
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error