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. 2016 May 26:17:405.
doi: 10.1186/s12864-016-2708-0.

Nosocomial transmission of Clostridium difficile ribotype 027 in a Chinese hospital, 2012-2014, traced by whole genome sequencing

Hongbing Jia  1 , Pengcheng Du  2   3 , Hui Yang  1 , Yuanyuan Zhang  2   3 , Jing Wang  1 , Wen Zhang  3   4 , Guiling Han  1 , Na Han  3   4 , Zhiyuan Yao  1 , Haiyin Wang  3   4 , Jing Zhang  1 , Zhen Wang  3   4 , Qingming Ding  1 , Yujun Qiang  3   4 , Frédéric Barbut  5 , George F Gao  6 , Yongtong Cao  7 , Ying Cheng  8 , Chen Chen  9   10
Affiliations

Nosocomial transmission of Clostridium difficile ribotype 027 in a Chinese hospital, 2012-2014, traced by whole genome sequencing

Hongbing Jia et al. BMC Genomics. .

Abstract

Background: The rapid spread of Clostridium difficile NAP1/BI/027 (C. difficile 027) has become one of the leading threats of healthcare-associated infections worldwide. However, C. difficile 027 infections have been rarely reported in Asia, particularly in China.

Results: In this study, we identified a rare C. difficile bloodstream infection (BSI) from three isolates of a patient during repeated hospital admission. This finding triggered a retrospective epidemiological study to scan all cases and strains emerged from this ward during the past three years. Using medical personnel interviews, medical record reviews and the genomic epidemiology, two outbreaks in 2012 and 2013-2014 were identified. Through using whole genome sequencing, we succeeded to trace the origin of the BSI strain. Surprisingly, we found the genome sequences were similar to C. difficile 027 strain R20291, indicating the occurrence of a rare C. difficile 027 strain in China. Integrated epidemiological investigation and whole genome sequencing of all strains, we constructed a nosocomial transmission map of these two C. difficile 027 outbreaks and traced the origin of the infection.

Conclusions: By genome sequencing, spatio-temporal analysis and field epidemiology investigation, we can estimate their complex transform network and reveal the possible modes of transmission in this ward. Based on their genetic diversity, we can assume that the toilets, bathroom, and janitor's equipment room may be contaminated area, which may be suggested to improve infection control measures in the following health care.

Keywords: Clostridium difficile; NAP1/BI/027; Nosocomial infection; Outbreak; Whole genome sequencing.

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Figures

Fig. 1
Fig. 1
Occurrence of CDI in this ward from March 2012 to May 2014. The x-axis represents the time line and the y-axis represents the patient ID. The green bars represent the period of hospital stay of each patient, the purple and yellow lines represent the dates of bouts of diarrhea and C. difficile isolation, respectively. The isolate 13B from blood is marked by a red star (the same in other figures). The number of new cases in each month is displayed using vertical bars at the top, red for NAP1/BI/027 cases, and gray for remaining cases
Fig. 2
Fig. 2
Capillary gel electrophoresis fingerprint of ribotyping of all C. difficile strains isolated from CDI patients in this study. Each lane represents as following: lane M, DNA marker (15 ~ 1500 bp); lane UK1, reference strain UK1 (NAP1/BI/RT027); other lanes, the 22 isolates from 20 CDI patients
Fig. 3
Fig. 3
a Phylogenetic tree of 22 isolates from this study and two reference strains R20291 (ST1) and M68 (ST37) reconstructed by BEAST based on the multi-mapping results of REALPHY. The strain ID is coordinate to patient ID. b SNP pattern and relationship of NAP1/BI/027 isolates. Thirteen isolates from 11 cases (13A, 13B, and 13C were all from patient 13) are clustered using NAP1/BI/027 strain R20291 as the outgroup. The light blue squares represent mutations compared to R20291
Fig. 4
Fig. 4
The temporal and spatial transmission map with three potential risks for C. difficile NAP1/BI/027 spreading. The transmission connections in two consecutive years were marked using blue and red lines, respectively. The full lines represent the potential transfer route with both genomics and epidemic evidence, and dashed lines connected the patients among whom only have potential genetic links. ”?” represented the unknown nodes during the transmission and evolution. The architectural structure, room arrangement, and distribution of NAP1/BI/027 cases in this ward were displayed at the bottom. Patients during the two outbreaks are distinguished by different colors of background: red for those in 2012 and blue for those in 2013 to 2014
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References

    1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–208. doi: 10.1056/NEJMoa1306801. - DOI - PMC - PubMed
    1. Kuijper EJ, Barbut F, Brazier JS, et al. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill 2008;13(31). - PubMed
    1. McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353(23):2433–41. doi: 10.1056/NEJMoa051590. - DOI - PubMed
    1. Heinlen L, Ballard JD. Clostridium difficile infection. Am J Med Sci. 2010;340(3):247–52. doi: 10.1097/MAJ.0b013e3181e939d8. - DOI - PMC - PubMed
    1. Loo VG, Poirier L, Miller MA, 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. doi: 10.1056/NEJMoa051639. - DOI - PubMed

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