Increased incidence of Clostridium difficile PCR ribotype 027 in Hesse, Germany, 2011 to 2013

M Arvand; D Vollandt; G Bettge-Weller; C Harmanus; E J Kuijper; Collective the Clostridium difficile study group Hesse

doi:10.2807/1560-7917.ES2014.19.10.20732

Surveillance and outbreak reports Open Access

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Increased incidence of Clostridium difficile PCR ribotype 027 in Hesse, Germany, 2011 to 2013

M Arvand¹, D Vollandt¹, G Bettge-Weller¹, C Harmanus², E J Kuijper², Collective the Clostridium difficile study group Hesse³
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Affiliations: ¹ Hesse State Health Office, Centre for Health Protection, Dillenburg, Germany ² Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands ³ The members of the group are listed at the end of the article

Correspondence:
M Arvand
mardjan.arvand hlpug.hessen.de
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Citation style for this article: Arvand M, Vollandt D, Bettge-Weller G, Harmanus C, Kuijper E J, the Clostridium difficile study group Hesse Collective. Increased incidence of Clostridium difficile PCR ribotype 027 in Hesse, Germany, 2011 to 2013. Euro Surveill. 2014;19(10):pii=20732. https://doi.org/10.2807/1560-7917.ES2014.19.10.20732 Received: 30 Nov 2013

Abstract

After the first outbreak of Clostridium difficile PCR ribotype (RT) 027 in Germany in 2007, no further outbreaks were reported until the recent re-emergence of RT 027 in Hesse, a federal state with 6 million inhabitants located in south-west Germany. We undertook a survey to determine the prevalence of RT 027 and other strains in a prospective study. From January 2011 to July 2013, we analysed 291 specimens from patients diagnosed with C. difficile infection (CDI) in 40 healthcare facilities in Hesse. The mean incidence of CDI in hospitals including at least 10 patients in the survey was 9.9 per 10,000 patient days (range 4.8-22.8) in November 2012. We obtained 214 toxigenic C. difficile isolates. RT 001 was the most prevalent (31.8%). RT 027, the second most common type (26.6%), was prevalent in all hospitals (n=14) from which at least seven isolates were available for typing, but its frequency varied considerably (range: 9.1-70%). The annual frequency of RT 027 increased from 21.4% in 2011 to 30.0% in 2013 (p=0.04). Our study indicates that infections with C. difficile RT 027 are now prevalent in Hesse. It underscores the need for surveillance programmes to analyse the molecular epidemiology of C. difficile. .