A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility
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 infecti...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2016-11, Vol.37 (11), p.1337-1341 |
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| creator | Cassir, Nadim Delarozière, Jean-Christophe Dubourg, Gregory Delord, Marion Lagier, Jean-Christophe Brouqui, Phillipe Fenollar, Florence Raoult, Didier Fournier, Pierre Edouard |
| description | 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-Côte-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 |
| doi_str_mv | 10.1017/ice.2016.164 |
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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-Côte-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. Infect Control Hosp Epidemiol 2016;1-5.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2016.164</identifier><identifier>PMID: 27484769</identifier><language>eng</language><publisher>New York, USA: Cambridge University Press</publisher><subject>Aged ; Aged, 80 and over ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Clostridium difficile - genetics ; Clostridium difficile - isolation & purification ; Clostridium Infections - diagnosis ; Clostridium Infections - epidemiology ; Clostridium Infections - prevention & control ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Cross Infection - prevention & control ; Diarrhea ; Diarrhea - epidemiology ; Diarrhea - microbiology ; Diarrhea - prevention & control ; Disease control ; Disease Outbreaks ; Disease prevention ; Epidemics ; Female ; France - epidemiology ; Health facilities ; Hospitals ; Human health and pathology ; Humans ; Infection Control - methods ; Infections ; Infectious diseases ; Laboratories ; Life Sciences ; Long term health care ; Long-Term Care ; Male ; Mortality ; Nursing ; Original Articles ; Outbreaks ; Patients ; Real-Time Polymerase Chain Reaction ; Risk Factors ; Sex ratio ; Spatio-Temporal Analysis ; Surveys and Questionnaires</subject><ispartof>Infection control and hospital epidemiology, 2016-11, Vol.37 (11), p.1337-1341</ispartof><rights>2016 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-62a6328116df1fd568e1be7ce4822f964f0620f8f4dfbf2825b05069e3e98203</citedby><cites>FETCH-LOGICAL-c458t-62a6328116df1fd568e1be7ce4822f964f0620f8f4dfbf2825b05069e3e98203</cites><orcidid>0000-0002-2895-5824 ; 0000-0002-7517-0173 ; 0000-0002-5276-6986 ; 0000-0002-0633-5974</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2799879476/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2799879476?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>164,230,314,780,784,885,21388,21389,23256,27924,27925,33530,33531,33703,33704,33744,33745,43659,43787,43805,55628,64385,64387,64389,72469,74104,74283,74302</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27484769$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-01453291$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Cassir, Nadim</creatorcontrib><creatorcontrib>Delarozière, Jean-Christophe</creatorcontrib><creatorcontrib>Dubourg, Gregory</creatorcontrib><creatorcontrib>Delord, Marion</creatorcontrib><creatorcontrib>Lagier, Jean-Christophe</creatorcontrib><creatorcontrib>Brouqui, Phillipe</creatorcontrib><creatorcontrib>Fenollar, Florence</creatorcontrib><creatorcontrib>Raoult, Didier</creatorcontrib><creatorcontrib>Fournier, Pierre Edouard</creatorcontrib><title>A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility</title><title>Infection control and hospital epidemiology</title><addtitle>Infect. Control Hosp. Epidemiol</addtitle><description>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-Côte-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. Infect Control Hosp Epidemiol 2016;1-5.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Clostridium difficile - genetics</subject><subject>Clostridium difficile - isolation & purification</subject><subject>Clostridium Infections - diagnosis</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - prevention & control</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - prevention & control</subject><subject>Diarrhea</subject><subject>Diarrhea - epidemiology</subject><subject>Diarrhea - microbiology</subject><subject>Diarrhea - prevention & control</subject><subject>Disease control</subject><subject>Disease Outbreaks</subject><subject>Disease prevention</subject><subject>Epidemics</subject><subject>Female</subject><subject>France - epidemiology</subject><subject>Health facilities</subject><subject>Hospitals</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Infection Control - methods</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Laboratories</subject><subject>Life Sciences</subject><subject>Long term health care</subject><subject>Long-Term Care</subject><subject>Male</subject><subject>Mortality</subject><subject>Nursing</subject><subject>Original Articles</subject><subject>Outbreaks</subject><subject>Patients</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>Risk Factors</subject><subject>Sex ratio</subject><subject>Spatio-Temporal Analysis</subject><subject>Surveys and Questionnaires</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNptkUFr2zAYQMVYWbNut52HYJcO6kySZVk6BrO0hUBHmsNuQrY_pepsK5PsQX5A_3cVknVQdhKI9z2J7yH0iZI5JbT85hqYM0LFnAr-Bs1oUahMyJy_RTMilcoky3-eo_cxPhJCSqXoO3TOSi55KdQMPS3wGrbOD6bDd9NYBzC_sLe46nwcg2vd1OPWWesa1wH-Ua2ztav9uN8BJqzEt4OFZkzjEbsB3_tpfAATRwgDXgYzNIBt8D02-N4N2yRY-WGbbSD0uDIB8NIkrRv3H9CZNV2Ej6fzAm2W3zfVTba6u76tFqus4YUcM8GMyJmkVLSW2rYQEmgNZQNcMmaV4JYIRqy0vLW1ZZIVNSmIUJCDkozkF-jrUftgOr0Lrjdhr71x-max0oc7QnmRM0X_0MReHtld8L8niKPuXWyg68wAfoqaSiZKzoQ4aL-8Qh_9FNJGo2Zp4bJUadeJujpSTfAxBrAvP6BEH0rqVFIfSupUMuGfT9Kp7qF9gf-mS8D85DN9nUpt4d-z_zU-AzPHpnw</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Cassir, Nadim</creator><creator>Delarozière, Jean-Christophe</creator><creator>Dubourg, Gregory</creator><creator>Delord, Marion</creator><creator>Lagier, Jean-Christophe</creator><creator>Brouqui, Phillipe</creator><creator>Fenollar, Florence</creator><creator>Raoult, Didier</creator><creator>Fournier, Pierre Edouard</creator><general>Cambridge University Press</general><general>University of Chicago Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-2895-5824</orcidid><orcidid>https://orcid.org/0000-0002-7517-0173</orcidid><orcidid>https://orcid.org/0000-0002-5276-6986</orcidid><orcidid>https://orcid.org/0000-0002-0633-5974</orcidid></search><sort><creationdate>20161101</creationdate><title>A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility</title><author>Cassir, Nadim ; Delarozière, Jean-Christophe ; Dubourg, Gregory ; Delord, Marion ; Lagier, Jean-Christophe ; Brouqui, Phillipe ; Fenollar, Florence ; Raoult, Didier ; Fournier, Pierre Edouard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-62a6328116df1fd568e1be7ce4822f964f0620f8f4dfbf2825b05069e3e98203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotics</topic><topic>Clostridium difficile - genetics</topic><topic>Clostridium difficile - isolation & purification</topic><topic>Clostridium Infections - diagnosis</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - prevention & control</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - prevention & control</topic><topic>Diarrhea</topic><topic>Diarrhea - epidemiology</topic><topic>Diarrhea - microbiology</topic><topic>Diarrhea - prevention & control</topic><topic>Disease control</topic><topic>Disease Outbreaks</topic><topic>Disease prevention</topic><topic>Epidemics</topic><topic>Female</topic><topic>France - epidemiology</topic><topic>Health facilities</topic><topic>Hospitals</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Infection Control - methods</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Laboratories</topic><topic>Life Sciences</topic><topic>Long term health care</topic><topic>Long-Term Care</topic><topic>Male</topic><topic>Mortality</topic><topic>Nursing</topic><topic>Original Articles</topic><topic>Outbreaks</topic><topic>Patients</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>Risk Factors</topic><topic>Sex ratio</topic><topic>Spatio-Temporal Analysis</topic><topic>Surveys and Questionnaires</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cassir, Nadim</creatorcontrib><creatorcontrib>Delarozière, Jean-Christophe</creatorcontrib><creatorcontrib>Dubourg, Gregory</creatorcontrib><creatorcontrib>Delord, Marion</creatorcontrib><creatorcontrib>Lagier, Jean-Christophe</creatorcontrib><creatorcontrib>Brouqui, Phillipe</creatorcontrib><creatorcontrib>Fenollar, Florence</creatorcontrib><creatorcontrib>Raoult, Didier</creatorcontrib><creatorcontrib>Fournier, Pierre Edouard</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cassir, Nadim</au><au>Delarozière, Jean-Christophe</au><au>Dubourg, Gregory</au><au>Delord, Marion</au><au>Lagier, Jean-Christophe</au><au>Brouqui, Phillipe</au><au>Fenollar, Florence</au><au>Raoult, Didier</au><au>Fournier, Pierre Edouard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect. Control Hosp. Epidemiol</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>37</volume><issue>11</issue><spage>1337</spage><epage>1341</epage><pages>1337-1341</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>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-Côte-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. Infect Control Hosp Epidemiol 2016;1-5.</abstract><cop>New York, USA</cop><pub>Cambridge University Press</pub><pmid>27484769</pmid><doi>10.1017/ice.2016.164</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0002-2895-5824</orcidid><orcidid>https://orcid.org/0000-0002-7517-0173</orcidid><orcidid>https://orcid.org/0000-0002-5276-6986</orcidid><orcidid>https://orcid.org/0000-0002-0633-5974</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Anti-Bacterial Agents - therapeutic use Antibiotics Clostridium difficile - genetics Clostridium difficile - isolation & purification Clostridium Infections - diagnosis Clostridium Infections - epidemiology Clostridium Infections - prevention & control Cross Infection - epidemiology Cross Infection - microbiology Cross Infection - prevention & control Diarrhea Diarrhea - epidemiology Diarrhea - microbiology Diarrhea - prevention & control Disease control Disease Outbreaks Disease prevention Epidemics Female France - epidemiology Health facilities Hospitals Human health and pathology Humans Infection Control - methods Infections Infectious diseases Laboratories Life Sciences Long term health care Long-Term Care Male Mortality Nursing Original Articles Outbreaks Patients Real-Time Polymerase Chain Reaction Risk Factors Sex ratio Spatio-Temporal Analysis Surveys and Questionnaires |
| title | A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility |
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