Clostridium difficile: Transmissibility and genotypic features
Research Project
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01.02.2012
- 31.01.2013
Patients undergoing antimicrobiol therapy in hospitals suffer frequently from diarrhea due to Clostridium difficile. New strains of this bacteria emerged during the last decade and are associated with increased mortality from 2 - 20 %. The pathogenesis of the disease is complex: it requires exposure to C. difficile, an alteration of the microbial flora in the gut, and a lack of antibody against this pathogen. Antibiotics are the leading source for changing of the colonic flora putting even the non-immunocompromised patients at risk for developing C. difficile associated diarrhea (CDAD). The new strains are called PCR Ribotyp 027 and PCR Ribotyp 078. The key features of these strains are the release of toxins that ultimately lead to the disease. Multiple outbreaks with C. difficile have been published with these 027 and 078 strains. Therefore, public health authorities such as the European and the Centers for disease Control and Prevention (Atlanta, USA) require the isolation of affected patients in hospitals to prevent spread of all C. difficile patients, especially those epidemiologically important cases with PCR Ribotyp 027 and 078. The detection of C. difficile is - as the name implies - difficult. This study will evaluate the rate of transmission of C. difficile, stratified by common strains and those epidemiologically important 027 and 078 strains. Most clinical laboratories in hospital do not isolate C. difficile from clinical specimens, but rely on simple direct toxin detection. Therefore, the epidemiology of C. difficile in Switzerland is unknown because the sensitivity of this test to detect toxin-positive C. difficile is around 50%. In addition, PCR ribotyping is not routinely performed to detect the 027 or 078 strains. The first step of the study is the implementation of state-of-the art methodology to detect strains of C. difficile followed by PCR ribotyping to detect this epidemiologically important strain. Patients exposed to a patient who is identified as a case will be screened for C. difficile. The results of this study will allow to provide a detailed epidemiology of the different C. difficile strains in our institution, and provide an estimate of extend of spread. Our hypothesis is that only these epidemiologically important strains 027 or 078 require contact isolation, and the 95% of all other strains can be placed on standard precautions. This would lead to savings of more than one million Swiss Francs a year per large hospital. It would improve patient comfort and potentially quality of care. In addition, the impact of environmental contamination will be analyzed as well. The results will be compared with the German national database (Leader: Prof. P. Gastmeier, Berlin). In addition, Basel was elected as National reference center for the surveillance of C. difficile in Europe (Leader: J.Kuijper, Leiden, the Netherlands). mayTransmission is linked to contamination of the environment, contaminated hands of healthcare workers
