Cassir N., Delaroziere J. C., Dubourg G., Delord M., Lagier J. C., Brouqui P., Fenollar F., Raoult Didier, Fournier P. E. (2016). A regional outbreak of Clostridium difficile PCR-ribotype 027 infections in Southeastern France from a single long-term Care facility. Infection Control and Hospital Epidemiology, 37 (11), p. 1337-1341. ISSN 0899-823X.
Titre du document
A regional outbreak of Clostridium difficile PCR-ribotype 027 infections in Southeastern France from a single long-term Care facility
Cassir N., Delaroziere J. C., Dubourg G., Delord M., Lagier J. C., Brouqui P., Fenollar F., Raoult Didier, Fournier P. E.
Source
Infection Control and Hospital Epidemiology, 2016,
37 (11), p. 1337-1341 ISSN 0899-823X
OBJECTIVE. To describe and analyze a large outbreak of Clostridium difficile 027 (CD-027) infections. METHODS. Confirmed CD-027 cases were defined as CD infection plus real-time polymerase chain reaction assay (PCR) positive for CD-027. Clinical and microbiological data on patients with CD-027 infection were collected from January 2013 to December 2015 in the Provence-Alpes-Cote-d'Azur region (southeastern France). RESULTS. In total, 19 healthcare facilities reported 144 CD-027 infections (112 confirmed and 32 probable CD-027 infections) during a 22-month period outbreak. Although the incidence rate per 10,000 bed days was lower in long-term care facilities (LTCFs) than in acute care facilities (0.05 vs 0.14; P < .001), cases occurred mainly in LTCFs, one of which was the probable source of this outbreak. After centralization of CD testing, the rate of confirmed CD-027 cases from LTCFs or residential-care homes increased significantly (69% vs 92%; P < .001). Regarding confirmed CD-027 patients, the sex ratio and the median age were 0.53 and 84.2 years, respectively. The 30-day crude mortality rate was 31%. Most patients (96%) had received antibiotics within 3 months prior to the CD colitis diagnosis. During the study period, the rate of patients with CD-027 (compared with all patients tested in the point-of-care laboratories) decreased significantly (P = .03). CONCLUSIONS. A large CD-027 outbreak occurred in southeastern France as a consequence of an initial cluster of cases in a single LTCF. Successful interventions included rapid isolation and testing of residents with potentially infectious diarrhea and cohorting of case patients in a specialized infectious diseases ward to optimize management.
