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

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:

• Clostridioides difficile
• CDI
• mortality
• outbreak
• epidemiology
• ribotyping
• whole-genome sequencing

Acknowledgments

We would like to acknowledge Ann-Margreth Olinder-Nielsen for reviewing medical records, Andreas Lägermo for retrieving statistical data, Linda Berglind for technical assistance, Malin Lager for constructing Figure 3, and Anders Håkansson for excellent linguistic and scientific input on the manuscript. Financial support was received from the Academy for Health and Care, Region Jönköping County, Sweden.

Disclosure statement

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

Additional information

Funding

This work was supported by Academy for Health and Care, Region Jönköping County, Sweden.