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Possible Interplay Between Hospital and Community Transmission of a Novel Clostridium Difficile Sequence Type 295 Recognized by Next-Generation Sequencing

  • Geraldine Moloney (a1), Micheál Mac Aogáin (a1), Maureen Kelleghan (a2), Brian O’Connell (a2), Caroline Hurley (a3), Elizabeth Montague (a3), Mary Conlon (a3), Helena Murray (a3) and Thomas R. Rogers (a1) (a2)...
Abstract
OBJECTIVE

To use next-generation sequencing (NGS) analysis to enhance epidemiological information to identify and resolve a Clostridium difficile outbreak and to evaluate its effectiveness beyond the capacity of current standard PCR ribotyping.

METHODS

NGS analysis was performed as part of prospective surveillance of all detected C. difficile isolates at a university hospital. An outbreak of a novel C. difficile sequence type (ST)-295 was identified in a hospital and a community hostel for homeless adults. Phylogenetic analysis was performed of all ST-295 and closest ST-2 isolates. Epidemiological details were obtained from hospital records and the public health review of the community hostel.

RESULTS

We identified 7 patients with C. difficile ST-295 infections between June 2013 and April 2015. Of these patients, 3 had nosocomial exposure to this infection and 3 had possible hostel exposure. Current Society for Healthcare Epidemiology of America (SHEA)— Infectious Diseases Society of America (IDSA) surveillance definitions (2010) were considered in light of our NGS findings. The initial transmission was not detectable using current criteria, because of 16 weeks between ST-295 exposure and symptoms. We included 3 patients with hostel exposure who met surveillance criteria of hospital-acquired infection due to their hospital admissions.

CONCLUSION

NGS analysis enhanced epidemiological information and helped identify and resolve an outbreak beyond the capacity of standard PCR ribotyping. In this cluster of cases, NGS was used to identify a hostel as the likely source of community-based C. difficile transmission.

Infect Control Hosp Epidemiol 2016;37:680–684

Copyright
Corresponding author
Address correspondence to Geraldine Moloney, Department of Clinical Microbiology, Sir Patrick Dun Translational Research Laboratory, Trinity College Dublin, St James’s Hospital, Dublin, Ireland.
References
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1. Gerding, DN, Lessa, FC. The epidemiology of Clostridium difficile infection inside and outside health care institutions. Infect Dis Clin North Am 2015;29:3750.
2. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013;369:11951205.
3. Cohen, SH, Gerding, DN, Johnson, S, 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;31:431455.
4. Chitnis, AS, Holzbauer, SM, Belflower, RM, et al. Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 2013;173:13591367.
5. Sadowski, LS, Kee, RA, VanderWeele, TJ, Buchanan, D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009;301:17711778.
6. Kmietowicz, Z. NICE advises screening for TB in hostels and prisons to reduce UK cases. BMJ 2012;344:e2309.
7. Neale, J, Stevenson, C. Routine exposure to blood within hostel environments might help to explain elevated levels of hepatitis C amongst homeless drug users: insights from a qualitative study. Int J Drug Policy 2012;23:248250.
8. Mac Aogáin, M, Moloney, G, Kilkenny, S, Kelleher, M, Kelleghan, M, Boyle, B. Whole-genome sequencing improves discrimination of relapse from reinfection and identifies transmission events among patients with recurrent Clostridium difficile infections. J Hosp Infect 2015;90:108116.
9. Guindon, S, Dufayard, JR, Lefort, V, Anisimova, M, Hordijk, W, Gascuel, O. New algorithms and methods to estimate maximum-likelihood phylogenies: assessing the performance of PhyML 3.0. Syst Biol 2010;59:307321.
10. Griffiths, D, Fawley, W, Kachrimanidou, M, et al. Multilocus sequence typing of Clostridium difficile . J Clin Microbiol 2010;48:770778.
11. Housekeeping Manual for Municipally Operated Shelters. Hostel Services, Toronto Shelter, Support and Housing Administration website. http://www1.toronto.ca/City%20Of%20Toronto/Shelter%20Support%20&%20Housing%20Administration/Files/pdf/H/Housekeeping%20Manual%20-%20March%202013%20Version_1.pdf. Published 2013. Accessed July 23, 2015.
12. National Clinical Effectiveness Committee. Surveillance, Diagnosis and Management of Clostridium difficile Infection in Ireland. National Guideline No. 3. Health Protection Surveillance Centre website. http://www.hpsc.ie/A-Z/Gastroenteric/Clostridiumdifficile/Guidelines/File,13950,en.pdf. Published 2014. Accessed July 23, 2015.
13. McDonald, LC, Coignard, B, Dubberke, E, et al. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140145.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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