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. 2022 Dec;11(1):850-859.
doi: 10.1080/22221751.2022.2049981.

Characterization of a Clostridioides difficile outbreak caused by PCR ribotype 046, associated with increased mortality

Cecilia Magnusson  1 , Sara Mernelius  2 , Malin Bengnér  3 , Torbjörn Norén  4 , Lena Serrander  5 , Sophie Forshell  1 , Andreas Matussek  2   6   7
Affiliations

Characterization of a Clostridioides difficile outbreak caused by PCR ribotype 046, associated with increased mortality

Cecilia Magnusson et al. Emerg Microbes Infect. 2022 Dec.

Abstract

This study describes a large nosocomial outbreak of Clostridioides difficile infections (CDI) dominated by ribotype (RT) 046 in a Swedish hospital. The present study aimed to examine the pathogenicity of this RT, explore epidemiological links by whole genome sequencing (WGS), and evaluate different interventions implemented to stop the outbreak. Clinical isolates (n = 366) collected during and after the outbreak were ribotyped and 246 isolates were subjected to WGS. Medical records of patients infected with the seven most common RTs were evaluated. RT046 was spread effectively throughout the hospital and was the most common among the 44 different RTs found (114/366 isolates). Infection with RT046 was associated with higher mortality compared to other strains (20.2% to 7.8%), although there were no differences in concomitant disease, age or antibiotic treatment. To control the outbreak, several measures were successfully implemented.

Keywords: CDI; Clostridioides difficile; epidemiology; mortality; outbreak; ribotyping; whole-genome sequencing.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Flowchart of isolates included in the study from Högland Hospital catchment area, 2010–2011.
Figure 2.
Figure 2.
Timeline for CDI outbreak and interventions at Högland Hospital. Epidemiological curve showing CDI cases caused by RT046 at different wards at Högland Hospital during the outbreak (2010–2011) and CDI cases/10,000 bed days (July 2011–2013).
Figure 3.
Figure 3.
One-year survival rate after CDI among patients infected with C. difficile of RT046 (dashed line) compared to the comparison group (continuous line).
Figure 4.
Figure 4.
Ridom SeqSphere+ minimum spanning tree (MST) for 222 samples based on 2583 targets, pairwise ignoring missing values. Each colour of the circles represents a different ribotype. The size of the circles is not proportional to the number of isolates. The number on the lines shows the number of allelic differences. The length of the lines is not proportional to the allelic differences. Each number in the circles represents a single isolate and is according to the sampling date.
See this image and copyright information in PMC

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