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Abstract

As part of the European infections (CDI) surveillance Network (ECDIS-Net), which aims to build capacity for CDI surveillance in Europe, we constructed a new network of hospital-based laboratories in Poland. We performed a survey in 13 randomly selected hospital-laboratories in different sites of the country to determine their annual CDI incidence rates from 2011 to 2013. Information on laboratory diagnostic testing and indications for testing was also collected. Moreover, for 2012 and 2013 respectively, participating hospital-laboratories sent all consecutive isolates from CDI patients between February and March to the Anaerobe Laboratory in Warsaw for further molecular characterisation, including the detection of toxin-encoding genes and polymerase chain reaction (PCR)-ribotyping. Within the network, the mean annual hospital CDI incidence rates were 6.1, 8.6 and 9.6 CDI per 10,000 patient-days in 2011, 2012, and 2013 respectively. Six of the 13 laboratories tested specimens only on the request of a physician, five tested samples of antibiotic-associated diarrhoea or samples from patients who developed diarrhoea more than two days after admission (nosocomial diarrhoea), while two tested all submitted diarrhoeal faecal samples. Most laboratories (9/13) used tests to detect glutamate dehydrogenase and toxin A/B either separately or in combination. In the two periods of molecular surveillance, a total of 166 strains were characterised. Of these, 159 were toxigenic and the majority belonged to two PCR-ribotypes: 027 (n = 99; 62%) and the closely related ribotype 176 (n = 22; 14%). The annual frequency of PCR-ribotype 027 was not significantly different during the surveillance periods (62.9% in 2012; 61.8% in 2013). Our results indicate that CDIs caused by PCR-ribotype 027 predominate in Polish hospitals participating in the surveillance, with the closely related 176 ribotype being the second most common agent of infection.

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/content/10.2807/1560-7917.ES.2015.20.38.30025
2015-09-24
2024-04-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2015.20.38.30025
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References

  1. Peniche AG, Savidge TC, Dann SM. Recent insights into Clostridium difficile pathogenesis. Curr Opin Infect Dis. 2013;26(5):447-53.  https://doi.org/10.1097/01.qco.0000433318.82618.c6  PMID: 23982235 
  2. Muto CA, Blank MK, Marsh JW, Vergis EN, O’Leary MM, Shutt KA, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive "bundle" approach. Clin Infect Dis. 2007;45(10):1266-73.  https://doi.org/10.1086/522654  PMID: 17968819 
  3. McDonald LC, Killgore GE, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353(23):2433-41.  https://doi.org/10.1056/NEJMoa051590  PMID: 16322603 
  4. Loo VG, Poirier L, Miller MA, Oughton M, Libman MD, Michaud S, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353(23):2442-9.  https://doi.org/10.1056/NEJMoa051639  PMID: 16322602 
  5. Bartlett JG. Narrative review: the new epidemic of Clostridium difficile-associated enteric disease. Ann Intern Med. 2006;145(10):758-64.  https://doi.org/10.7326/0003-4819-145-10-200611210-00008  PMID: 17116920 
  6. Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet. 2005;366(9491):1079-84.  https://doi.org/10.1016/S0140-6736(05)67420-X  PMID: 16182895 
  7. Kuijper EJ, Barbut F, Brazier JS, Kleinkauf N, Eckmanns T, Lambert ML, et al. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill. 2008;13(31):18942. PMID: 18761903 
  8. Birgand G, Blanckaert K, Carbonne A, Coignard B, Barbut F, Eckert C, et al. Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006-2007 and associated clusters in 2008-2009. Euro Surveill. 2010;15(25):19597. PMID: 20587362 
  9. Kuijper EJ, van den Berg RJ, Debast S, Visser CE, Veenendaal D, Troelstra A, et al. Clostridium difficile ribotype 027, toxinotype III, the Netherlands. Emerg Infect Dis. 2006;12(5):827-30.  https://doi.org/10.3201/eid1205.051350  PMID: 16704846 
  10. Smith A. Outbreak of Clostridium difficile infection in an English hospital linked to hypertoxin-producing strains in Canada and the US. Euro Surveill. 2005;10(26): 2735. PMID: 16783109 
  11. Starzengruber P, Segagni Lusignani L, Wrba T, Mitteregger D, Indra A, Graninger W, et al. Severe Clostridium difficile infection: incidence and risk factors at a tertiary care university hospital in Vienna, Austria. Wien Klin Wochenschr. 2014;126(13-14):427-30.  https://doi.org/10.1007/s00508-014-0549-x  PMID: 24903143 
  12. Oleastro M, Coelho M, Gião M, Coutinho S, Mota S, Santos A, et al. Outbreak of Clostridium difficile PCR ribotype 027--the recent experience of a regional hospital. BMC Infect Dis. 2014;14(1):209.  https://doi.org/10.1186/1471-2334-14-209  PMID: 24739945 
  13. Rafila A, Indra A, Popescu GA, Wewalka G, Allerberger F, Benea S, et al. Occurrence of Clostridium difficile infections due to PCR ribotype 027 in Bucharest, Romania. J Infect Dev Ctries. 2014;8(6):694-8.  https://doi.org/10.3855/jidc.4435  PMID: 24916866 
  14. Popescu GA, Florea D, Rafila A. Clostridium difficile is emerging in Romania: a story of 027 ribotype and excessive antibiotic consumption. J Gastrointestin Liver Dis. 2014;23(3):342-3. PMID: 25267968 
  15. He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013;45(1):109-13.  https://doi.org/10.1038/ng.2478  PMID: 23222960 
  16. Pituch H, Bakker D, Kuijper E, Obuch-Woszczatyński P, Wultańska D, Nurzyńska G, et al. First isolation of Clostridium difficile PCR-ribotype 027/toxinotype III in Poland. Pol J Microbiol. 2008;57(3):267-8. PMID: 19004250 
  17. Nyč O, Pituch H, Matějková J, Obuch-Woszczatynski P, Kuijper EJ. Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland. Lancet. 2011;377(9775):1407.  https://doi.org/10.1016/S0140-6736(11)60575-8  PMID: 21515161 
  18. Obuch-Woszczatyński P, Lachowicz D, Schneider A, Mól A, Pawłowska J, Ożdżeńska-Milke E, et al. Occurrence of Clostridium difficile PCR-ribotype 027 and it’s closely related PCR-ribotype 176 in hospitals in Poland in 2008-2010. Anaerobe. 2014;28:13-7.  https://doi.org/10.1016/j.anaerobe.2014.04.007  PMID: 24799338 
  19. Kuijper EJ, Coignard B, Tüll PESCMID Study Group for Clostridium difficileEU Member StatesEuropean Centre for Disease Prevention and Control. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect. 2006;12(s6) Suppl 6;2-18.  https://doi.org/10.1111/j.1469-0691.2006.01580.x  PMID: 16965399 
  20. Stubbs SL, Brazier JS, O’Neill GL, Duerden BI. PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol. 1999;37(2):461-3. PMID: 9889244 
  21. Davies KA, Longshaw CM, Davis GL, Bouza E, Barbut F, Barna Z, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208-19.  https://doi.org/10.1016/S1473-3099(14)70991-0  PMID: 25455988 
  22. Wilcox MH, Shetty N, Fawley WN, Shemko M, Coen P, Birtles A, et al. Changing epidemiology of Clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England. Clin Infect Dis. 2012;55(8):1056-63.  https://doi.org/10.1093/cid/cis614  PMID: 22784871 
  23. Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, Rupnik M, et al. ECDIS Study Group. Clostridium difficile infection in Europe: a hospital-based survey. Lancet. 2011;377(9759):63-73.  https://doi.org/10.1016/S0140-6736(10)61266-4  PMID: 21084111 
  24. Van Dorp SM, Kola A, Behnke M, Gastmeier P, Schmid D, Hajdu A, et al. C. difficile infections in acute care hospitals – results of the pilot study of a European surveillance initiative. Poster presented at: European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), 2014 May 10–13; Barcelona.
  25. Arvand M, Vollandt D, Bettge-Weller G, Harmanus C, Kuijper EJ, the Clostridium difficile study gro CClostridium difficile study group Hesse. Increased incidence of Clostridium difficile PCR ribotype 027 in Hesse, Germany, 2011 to 2013. Euro Surveill. 2014;19(10):20732.  https://doi.org/10.2807/1560-7917.ES2014.19.10.20732  PMID: 24650866 
  26. Krutova M, Nyc O, Kuijper EJ, Geigerova L, Matejkova J, Bergerova T, et al. A case of imported Clostridium difficile PCR-ribotype 027 infection within the Czech Republic which has a high prevalence of C. difficile ribotype 176. Anaerobe. 2014;30:153-5.  https://doi.org/10.1016/j.anaerobe.2014.09.020  PMID: 25300750 
  27. Spigaglia P, Barbanti F, Dionisi AM, Mastrantonio P. Clostridium difficile isolates resistant to fluoroquinolones in Italy: emergence of PCR ribotype 018. J Clin Microbiol. 2010;48(8):2892-6.  https://doi.org/10.1128/JCM.02482-09  PMID: 20554809 
Hospital-based Clostridium difficile infection surveillance reveals high proportions of PCR ribotypes 027 and 176 in different areas of Poland, 2011 to 2013
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Hanna+Pituch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pituch Hanna</a>, <a href="/search?value1=Piotr+Obuch-Woszczaty%C5%84ski&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Obuch-Woszczatyński Piotr</a>, <a href="/search?value1=Dominika+Lachowicz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lachowicz Dominika</a>, <a href="/search?value1=Dorota+Wulta%C5%84ska&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wultańska Dorota</a>, <a href="/search?value1=Pawel+Karpi%C5%84ski&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Karpiński Pawel</a>, <a href="/search?value1=Grazyna+M%C5%82ynarczyk&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Młynarczyk Grazyna</a>, <a href="/search?value1=Sofie+M+van+Dorp&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van Dorp Sofie M</a>, <a href="/search?value1=Ed+J+Kuijper&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuijper Ed J</a>, <a href="/search?value1=the+Polish+Clostridium+difficile+Study+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the Polish Clostridium difficile Study Group</a></span>. Hospital-based Clostridium difficile infection surveillance reveals high proportions of PCR ribotypes 027 and 176 in different areas of Poland, 2011 to 2013. <a href="/content/ecdc">Euro Surveill.</a> 2015;20(38):pii=30025. <a href="https://doi.org/10.2807/1560-7917.ES.2015.20.38.30025" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2015.20.38.30025</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 10 Nov 2014;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Jul 2015 </span> </p>
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