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A Sustained Outbreak of Clostridium difficile in a General Hospital: Persistance of a Toxigenic Clone in Four Units

Published online by Cambridge University Press:  02 January 2015

Swapan K. Nath ,
James H. Thornley ,
Mary Kelly ,
Bernadette Kucera ,
Stephen L.W. On ,
Barry Holmes  and
Menelaos Costas
Swapan K. Nath*
Affiliation:
Department of Laboratory Medicine, Henderson General Hospital Hamilton, Ontario, Canada
James H. Thornley
Affiliation:
Department of Laboratory Medicine, Henderson General Hospital Hamilton, Ontario, Canada
Mary Kelly
Affiliation:
Department of Laboratory Medicine, Henderson General Hospital Hamilton, Ontario, Canada
Bernadette Kucera
Affiliation:
Department of Infection Control, Henderson General Hospital Hamilton, Ontario, Canada
Stephen L.W. On
Affiliation:
National Collection of Type Cultures, Central Public Health Laboratory, London, England
Barry Holmes
Affiliation:
National Collection of Type Cultures, Central Public Health Laboratory, London, England
Menelaos Costas
Affiliation:
National Collection of Type Cultures, Central Public Health Laboratory, London, England
*
Department of Laboratory Medicine, Henderson General Hospital, Hamilton, Ontario, Canada, L8V 1C3
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Abstract

Objective:

To evaluate the endemicity and epidemiology of toxigenic Clostridium difficile in a sustained outbreak of antibiotic-associated diarrhea.

Setting:

University-affiliated, 465-bed tertiary care teaching hospital with adjacent cancer clinic in Hamilton, Ontario.

Design:

From August 8, 1991, through August 31, 1993, a total of 187 cases were investigated for epidemiologic analysis of toxigenic C difficile from stool cultures, to identify the endemic clone(s). To assess the nature of contamination, cultures of inanimate surfaces in the patient environment from the four most affected units (medical teaching, nonteaching medical, hematologic oncology, and the intensive care unit) were processed for C difficile. The 229 clinical strains and 24 environmental strains isolated were typed by numerical analysis of SDS-PAGE protein patterns.

Results:

A majority (81%) of cases in the epidemiologic analysis were associated with a toxigenic electrophoretic (EP) type 1 C difficile that was identical to the strain first isolated from an index case that occurred 18 months before the start of this study. Culture and typing of the C difficile strains from the inanimate surfaces in the four most affected units showed that the patient environment was contaminated with the toxigenic EP type 1 organism. Six other strains that occurred infrequently among cases also were found in the environment.

Conclusions:

A single predominant toxigenic clone has been implicated in a sustained outbreak of antibiotic-associated diarrhea that affected elderly patients. The “endemic” clone transmitted for the 25-month study period was linked to an index case shedding a toxigenic EP type 1 strain that occurred 21 months prior to the initial outbreak on the medical teaching unit. The patient environment in the affected units was found to be contaminated with the same clone, possibly due to shedding of organisms by fecally incontinent symptomatic patients. The extrinsic factors contributing to the endemic transmission of this one clone still are not well understood

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 6 , June 1994 , pp. 382 - 389
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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