08 November 2007
First isolation of Clostridium difficile PCR ribotype 027 in Finland
O Lyytikäinen (email@example.com)1, S Mentula1, E Könönen1, S Kotila1, E Tarkka3, V-J Anttila2, E Mattila2, M Kanerva2, M Vaara3, V Valtonen2
1. National Public Health Institute, Helsinki, Finland
2. Helsinki University Central Hospital, Helsinki, Finland
3. Helsinki Universital Hospital Laboratory, Helsinki, Finland
On 18 October 2007, the first case of Clostridium difficile
PCR ribotype 027-associated disease was detected in Finland. The strain was isolated from a middle-aged male patient who died from a severe pseudomembranous colitis. The patient had received antibiotics for a urinary tract infection. Epidemics of C. difficile
-associated disease (CDAD) due to this new, highly virulent strain have been recognised first in Canada and the United States, and thereafter in Europe , including in England and Wales, Ireland, the Netherlands, Belgium, Luxembourg and France, and has been detected in Austria, Scotland, Switzerland, Poland and Denmark .
Two additional cases caused by this new PCR ribotype were detected in a retrospective survey performed in the Helsinki and Uusimaa healthcare district in southern Finland between 2 May and 23 June 2007. In this survey, 85 consecutive isolates were further characterised by the Helsinki Universital Hospital Laboratory (HUSLAB) and the National Public Health Institute. These two additional strains had been isolated in May 2007 from two elderly patients with severe underlying conditions who both died from CDAD. All three strains were resistant to moxifloxacin; toxin production and toxinotype were not investigated. None of the three cases of C. difficile PCR ribotype 027-associated disease had connections with foreign countries and no connections between the cases could be identified. The attending physicians have been informed and further investigations are ongoing to identify potential additional cases.
The National Public Health Institute intensifies surveillance and control of CDAD. A proposal for revising the decree on communicable diseases is under preparation to include toxin-producing C. difficile in the National Infectious Disease Register which is based on the clinical microbiology laboratory notifications. The Finnish Hospital Infection Program (SIRO) has prepared a common protocol for CDAD surveillance in order to detect severe cases and epidemics caused by C. difficile. The SIRO program also provides training in surveillance methodology and control of CDAD. In addition, both the HUSLAB and National Public Health Institute are setting up molecular methods for rapid detection of C. difficile PCR ribotype 027.
- Emergence of Clostridium difficile-associated disease in Canada, the United States of America and Europe. Background document prepared by Dr Ed. J. Kuijper and Dr Peet Tüll on behalf of the European Study Group for Clostridium difficile and the European Centre for Disease Prevention and Control. 3 March 2006. Available from: http://www.ecdc.eu.int/documents/pdf/Cl_dif_v2.pdf
- Kuijper E, Coignard B, Brazier J, Suetens C, Drudy D, Wiuff C, and al. Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe. Euro Surveill 2007;12(6)[Epub ahead of print]. Available online: http://www.eurosurveillance.org/em/v12n06/1206-221.asp
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