Clostridioides difficile outbreak detection: Evaluation by ribotyping and whole-genome sequencing of a surveillance algorithm based on ward-specific cutoffs.

Autor:	Edman-Wallér JE; Centre for Antibiotic Resistance Research (CARe), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden., Toepfer M; Clinical Microbiology, Unilabs AB, Skövde, Sweden., Karp J; Centre for Antibiotic Resistance Research (CARe), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden., Rizzardi K; Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden., Jacobsson G; Centre for Antibiotic Resistance Research (CARe), Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden., Werner M; Department of Infection Prevention and Control, Södra Älvsborg Hospital, Borås, Sweden.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2023 Dec; Vol. 44 (12), pp. 1948-1952. Date of Electronic Publication: 2023 Jun 23.
DOI:	10.1017/ice.2023.113
Abstrakt:	Objective: We evaluated the performance of an early-warning algorithm, based on ward-specific incidence cutoffs for detecting Clostridioides difficile transmission in hospitals. We also sought to determine the frequency of intrahospital Clostridioides difficile transmission in our setting. Design: Diagnostic performance of the algorithm was tested with confirmed transmission events as the comparison criterion. Transmission events were identified by a combination of high-molecular-weight typing, ward history, ribotyping, and whole-genome sequencing (WGS). Setting: The study was conducted in 2 major and 2 minor secondary-care hospitals with adjacent catchment areas in western Sweden, comprising a total population of ∼480,000 and ∼1,000 hospital beds. Patients: All patients with a positive PCR test for Clostridioides difficile toxin B during 2020 and 2021. Methods: We conducted culturing and high-molecular-weight typing of all positive clinical samples. Ward history was determined for each patient to find possible epidemiological links between patients with the same type. Transmission events were determined by PCR ribotyping followed by WGS. Results: We identified 4 clusters comprising a total of 10 patients (1.5%) among 673 positive samples that were able to be cultured and then typed by high-molecular-weight typing. The early-warning algorithm performed no better than chance; patient diagnoses were made at wards other than those where the transmission events likely occurred. Conclusions: In surveillance of potential transmission, it is insufficient to consider only the ward where diagnosis is made, especially in settings with high strain diversity. Transmission within wards occurs sporadically in our setting.
Databáze:	MEDLINE
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