Characterisation of Clostridium difficile Hospital Ward–Based Transmission Using Extensive Epidemiological Data and Molecular Typing

摘要: Background Clostridium difficile infection (CDI) is a leading cause of antibiotic-associated diarrhoea and endemic in hospitals, hindering the identification sources routes transmission based on shared time space alone. This may compromise rational control despite costly prevention strategies. study aimed to investigate ward-based C. difficile, by subdividing outbreaks into distinct lineages defined multi-locus sequence typing (MLST). Methods Findings All toxin enzyme-immunoassay-positive culture-positive samples over 2.5 y from geographically population ~600,000 persons underwent MLST. Sequence types (STs) were combined with admission ward movement data an integrated comprehensive healthcare system incorporating three hospitals (1,700 beds) providing all acute care for geographical population. Networks cases potential events constructed each ST. Potential case timescales prior contact other sharing same From 1 September 2007 31 March 2010, there means 102 tests 9.4 CDIs per 10,000 overnight stays inpatients, 238 15.7 month outpatients/primary care. In total, 1,276 isolates 69 STs studied. MLST, no more than 25% could be linked inpatient source, ranging 37% renal/transplant, 29% haematology/oncology, 28% acute/elderly medicine 6% specialist surgery. Most putative transmissions identified occurred shortly (≤1 wk) after onset symptoms (141/218, 65%), few >8 wk (21/218, 10%). incubation periods ≤4 (132/218, 61%), >12 (28/218, 13%). Allowing persistent contamination following discharge CDI did not increase proportion allowing random meeting matched controls. Conclusions In setting well-implemented measures, symptomatic patients cannot account most new cases.