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A Regional Outbreak of Clostridium difficile PCR-Ribotype 027 Infections in Southeastern France from a Single Long-Term Care Facility

Published online by Cambridge University Press:  03 August 2016

Nadim Cassir ,
Jean-Christophe Delarozière ,
Gregory Dubourg ,
Marion Delord ,
Jean-Christophe Lagier ,
Phillipe Brouqui ,
Florence Fenollar ,
Didier Raoult  and
Pierre Edouard Fournier
Nadim Cassir
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille, France
Jean-Christophe Delarozière
Affiliation:
L’Antenne Régionale de Lutte contre les Infections Nosocomiales de la région en PACA, CCLIN, Marseille, France
Gregory Dubourg
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France
Marion Delord
Affiliation:
Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille, France
Jean-Christophe Lagier
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille, France
Phillipe Brouqui
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France Institut Hospitalo-Universitaire Méditerranée Infection, Assistance Publique Hôpitaux de Marseille, Centre Hospitalier Universitaire Nord, Marseille, France
Florence Fenollar
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France
Didier Raoult
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France
Pierre Edouard Fournier*
Affiliation:
Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, INSERM U1095, Méditerranée-Infection, Aix-Marseille-Université, Marseille, France
*
Address correspondence to Pierre E. Fournier, MD, PhD, Unité de Recherche sur les Maladies Infectieuses Tropicales et Emergentes, UMR CNRS-7278, IRD189, Méditerranée-Infection, Aix-Marseille-Université, 27 Boulevard Jean Moulin, 13385 Marseille cedex 05, France (pierre-edouard.fournier@univ-amu.fr).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 11 , November 2016 , pp. 1337 - 1341
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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