The Recent Emergence of Clostridium difficile Infection in Romanian Hospitals is Associated with a High Prevalence of Polymerase Chain Reaction Ribotype 027

Yıl 2018, Cilt: 35 Sayı: 2, 191 - 195, 01.03.2018

Gabriel Adrian Popescu Roxana Serban Adriana Pistol Andreea Niculcea Andreea Preda Daniela Lemeni İoana Sabina Macovei Daniela Tălăpan Alexandru Rafila Dragoş Florea

Öz

Aims: To investigate the epidemiology of Clostridium difficile infection in Romanian hospitals.Methods: A survey was conducted at nine hospitals throughout Romania between November 2013 and February 2014.Results: The survey identified 393 patients with Clostridium difficile infection. The median age was 67 years (range: 2-94 years); 56% of patients were aged >65 years. The mean prevalence of Clostridium difficile infection was 5.2 cases per 10.000 patient-days. The highest prevalences were 24.9 and 20 per 10.000 patient-days in hospitals specializing in gastroenterology and infectious diseases, respectively. Clostridium difficile infections were health care-associated in 70.5% patients and community-acquired in 10.2%. The origin was not determined in 19.3%. Clostridium difficile infection was severe in 12.3% of patients, and the in-hospital all-cause mortality was 8.8%. Polymerase chain reaction ribotype 027 had the highest prevalence in all participating hospitals and represented 82.6% of the total ribotyped isolates. The minimum inhibitory concentration of moxifloxacin was >4 μg/mL for 59 of 80 tested isolates (73.8%). Of 59 isolates, 54 were highly resistant to moxifloxacin (minimum inhibitory concentration ≥32 μg/mL), and the majority were polymerase chain reaction ribotype 027 (p<0.0001).Conclusion: The ribotype 027 was the predominant cause of Clostridium difficile infections in Romania. In some specialized hospitals, the prevalence of Clostridium difficile infection was higher than the European mean prevalence, and this demonstrates the need for strict adherence to infection control programs.

Anahtar Kelimeler

Clostridium difficile, epidemiology, ribotype 027, Romania

Kaynakça

• 1. Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, et al. Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications. Ann Surg 2002;235:363-72.
• 2. Eggertson L. Quebec puts up 20 million dollars for C. difficile fight. C Med Assoc J 2005;172:622.
• 3. Smith A. Outbreak of Clostridium difficile infection in an English hospital linked to hypertoxin-producing strains in Canada and the US. Eur Surveill 2005;10:E050630.
• 4. Kuijper EJ, Coignard B, Brazier JS, Suetens C, Drudy D, Wiuff C, et al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007;12:1-2.
• 5. 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;55:1056-63.
• 6. Rafila A, Indra A, Popescu GA, Wewalka G, Allerberger F, Benea S, et al. Occurrence of Clostridium difficile infections due to PCR ribotype 027 in Bucharest, Romania. J Infect Dev Ctries 2014;8:694-8.
• 7. Debast SB, Bauer MP, Kuijper EJ; European Society of Clinical Microbiology and Infectious Diseases. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014;20(Suppl 2):1-26.
• 8. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431-55.
• 9. Bidet P, Barbut F, Lalande V, Burghoffer B, Petit JC. Development of a new PCRribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing. FEMS Microbiol Lett 1999;175:261-6.
• 10. O’Neill GL, Ogunsola FT, Brazier JS, Duerden BI. Modification of a PCR-ribotyping method for application as a routine typing scheme for Clostridium difficile. Anaerobe 1996;2:205-9.
• 11. European Clostridium difficile infection study network (ECDISNET). Europe: Supporting capacity building for surveillance of Clostridium difficile. Leiden: ECDIS-NET. http://www.ecdisnet.eu.
• 12. Knetsch CW, Lawley TD, Hensgens MP, Corver J, Wilcox MW, Kuijper EJ. Current application and future perspectives of molecular typing methods to study Clostridium difficile infections. Euro Surveill 2013;18:20381.
• 13. Cheng JW, Xiao M, Kudinha T, Xu ZP, Hou X, Sun LY, et al. The First Two Clostridium difficile Ribotype 027/ST1 Isolates Identified in Beijing, China-an Emerging Problem or a Neglected Threat? Sci Rep 2016;6:18834.
• 14. Balassiano IT, Yates EA, Domingues RM, Ferreira EO. Clostridium difficile: a problem of concern in developed countries and still a mystery in Latin America. J Med Microbiol 2012;61:169-79.
• 15. López-Ureña D, Quesada-Gómez C, Miranda E, Fonseca M, Rodríguez-Cavallini E. Spread of epidemic Clostridium difficile NAP1/027 in Latin America: case reports in Panama. J Med Microbiol 2014;63:322-4.
• 16. 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;14:1208- 19
• 17. Barbut F, Ramé L, Petit A, Suzon L, de Chevigny A, Eckert C, et al. Prevalence of Clostridium difficile infection in hospitalized patients with diarrhea: results of a French prospective multicenter bi-annual point prevalence study. Presse Med 2015;44:75-83.
• 18. Benea S, Popescu GA, Badicut I, Florea D, Petrache D, Gavriliu L, et al. Clostridium difficile infections hospitalized in Romanian Institute of Infectious Diseases during the first three months of 2012. 4th International C. difficile Symposium, September Bled, Slovenia: 2012.
• 19. Spina A, Kerr KG, Cormican M, Barbut F, Eigentler A, Zerva L, et al. Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis. Clin Microbiol Infect 2015;21:719- 28.
• 20. Barbut F, Mastrantonio P, Delmée M, Brazier J, Kuijper E, Poxton I, et al. Prospective study of Clostridium difficile infections in Europe with phenotypic and