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Kuijper EJ, Barbut F, Brazier JS, Kleinkauf N, Eckmanns T, Lambert ML, Drudy D, Fitzpatrick F, Wiuff C, Brown DJ, Coia JE, Pituch H, Reichert P, Even J, Mossong J, Widmer AF, Olsen KE, Allerberger F, Notermans DW, Delmée M, Coignard B, Wilcox M, Patel B, Frei R, Nagy E, Bouza E, Marin M, Åkerlund T, Virolainen-Julkunen A, Lyytikäinen O, Kotila S, Ingebretsen A, Smyth B, Rooney P, Poxton IR, Monnet DL. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill 2008. [DOI: 10.2807/ese.13.31.18942-en] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Outbreaks of Clostridium difficile infections (CDI) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America and Europe. This emerging strain is referred to as PCR ribotype 027 (Type 027). Since 2005, individual countries have developed surveillance studies about the spread of type 027. C. difficile Type 027 has been reported in 16 European countries. It has been responsible for outbreaks in Belgium, Germany, Finland, France, Ireland, Luxembourg, The Netherlands, Switzerland and the United Kingdom (England, Wales, Northern Ireland and Scotland). It has also been detected in Austria, Denmark, Sweden, Norway, Hungary, Poland and Spain. Three countries experienced imported patients with CDI due to Type 027 who acquired the infection abroad. The antimicrobial resistance pattern is changing, and outbreaks due to clindamycin-resistant ermB positive Type 027 strains have occurred in three European countries. Ongoing epidemiological surveillance of cases of CDI, with periodic characterisation of the strains involved, is required to detect clustering of cases in time and space and to monitor the emergence of new, highly virulent clones.
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Affiliation(s)
- E J Kuijper
- National Reference Laboratory for Clostridium difficile. Leiden University Medical Center, Leiden, The Netherlands
| | - F Barbut
- National Reference Center for Clostridium difficile, Saint-Antoine Hospital, Paris, France
| | - J S Brazier
- Anaerobe Reference Laboratory, National Public Health Service for Wales Cardiff, University Hospital of Wales, Cardiff, United Kingdom
| | - N Kleinkauf
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M L Lambert
- Epidemiology Unit, Scientific Institute of Public Health, Brussels, Belgium
| | - D Drudy
- Centre for Food Safety, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - F Fitzpatrick
- Health Protection Surveillance Centre and Beaumont Hospital, Dublin, Ireland
| | - C Wiuff
- Health Protection Scotland, Section for Healthcare Associated Infection and Infection Control, Glasgow, United Kingdom
| | - D J Brown
- Scottish Clostridium difficile Reference Service, Stobhill Hospital, Glasgow, United Kingdom
| | - J E Coia
- Scottish Clostridium difficile Reference Service, Stobhill Hospital, Glasgow, United Kingdom
| | - H Pituch
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - P Reichert
- Division of Microbiology, National Public Health Laboratory, Luxembourg
| | - J Even
- Division of Microbiology, National Public Health Laboratory, Luxembourg
| | - J Mossong
- Division of Microbiology, National Public Health Laboratory, Luxembourg
| | - A F Widmer
- Division of Infectious diseases and Hospital Epidemiology, University Hospital, Basel, Switzerland
| | - K E Olsen
- National Reference Laboratory for Enteropathogens, Statens Serum Institut, Copenhagen, Denmark
| | - F Allerberger
- Österreichische Agentur für Gesundheit und Ernährungssicherheit (Austrian Agency for Health and Food Safety; AGES), Vienna, Austria
| | - D W Notermans
- Centrum Infectieziektebestrijding (Centre for Infectious Disease Control; CIb), Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment; RIVM), Bilthoven, The Netherlands
| | - M Delmée
- Microbiology Department, Saint-Luc University Hospital, Brussels, Belgium
| | - B Coignard
- Departement of Infectious Diseases, Institut de Veille Sanitaire (National Public Health Institute; InVS), Saint-Maurice, France
| | - M Wilcox
- Clostridium difficile Ribotyping Network for England (CDRNE), Health Protection Agency, Reference Leeds General Infirmary, Leeds, United Kingdom
| | - B Patel
- Health Protection Agency, London, United Kingdom
| | - R Frei
- Microbiology Laboratory, University Hospital, Basel, Switzerland
| | - E Nagy
- Department of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - E Bouza
- Department of Medical Microbiology, University General Hospital Gregorio Maranon, Madrid, Spain
| | - M Marin
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - T Åkerlund
- Smittskyddsinstitutet (Swedish Institute for Infectious Disease Control; SMI), Solna, Sweden
| | | | - O Lyytikäinen
- Kansanterveyslaitos (National Public Health Institute; KTL), Helsinki, Finland
| | - S Kotila
- Kansanterveyslaitos (National Public Health Institute; KTL), Helsinki, Finland
| | - A Ingebretsen
- Department of Infection Prevention, Rikshospitalet, Oslo, Norway
| | - B Smyth
- Health Protection Agency, Communicable Disease Surveillance Centre (Northern Ireland), Belfast, United Kingdom
| | - P Rooney
- Microbiology Laboratory Belfast City Hospital, Belfast, United Kingdom
| | - I R Poxton
- Medical Microbiology, Centre for Infectious Diseases, University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, United Kingdom
| | - D. L. Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Kuijper EJ, Barbut F, Brazier JS, Kleinkauf N, Eckmanns T, Lambert ML, Drudy D, Fitzpatrick F, Wiuff C, Brown DJ, Coia JE, Pituch H, Reichert P, Even J, Mossong J, Widmer AF, Olsen KE, Allerberger F, Notermans DW, Delmée M, Coignard B, Wilcox M, Patel B, Frei R, Nagy E, Bouza E, Marin M, Akerlund T, Virolainen-Julkunen A, Lyytikäinen O, Kotila S, Ingebretsen A, Smyth B, Rooney P, Poxton IR, Monnet DL. Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008. Euro Surveill 2008; 13:18942. [PMID: 18761903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Outbreaks of Clostridium difficile infections (CDI) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America and Europe. This emerging strain is referred to as PCR ribotype 027 (Type 027). Since 2005, individual countries have developed surveillance studies about the spread of type 027.C. difficile Type 027 has been reported in 16 European countries. It has been responsible for outbreaks in Belgium, Germany, Finland, France, Ireland, Luxembourg, The Netherlands, Switzerland and the United Kingdom (England, Wales, Northern Ireland and Scotland). It has also been detected in Austria, Denmark, Sweden, Norway, Hungary, Poland and Spain. Three countries experienced imported patients with CDI due to Type 027 who acquired the infection abroad.The antimicrobial resistance pattern is changing, and outbreaks due to clindamycin-resistant ermB positive Type 027 strains have occurred in three European countries. Ongoing epidemiological surveillance of cases of CDI, with periodic characterisation of the strains involved, is required to detect clustering of cases in time and space and to monitor the emergence of new, highly virulent clones.
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Affiliation(s)
- E J Kuijper
- National Reference Laboratory for Clostridium difficile. Leiden University Medical Center, Leiden, The Netherlands
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Kanerva M, Blom M, Tuominen U, Kolho E, Anttila VJ, Vaara M, Virolainen-Julkunen A, Lyytikäinen O. Costs of an outbreak of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2007; 66:22-8. [PMID: 17433492 DOI: 10.1016/j.jhin.2007.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 02/10/2007] [Indexed: 10/23/2022]
Abstract
An outbreak of meticillin-resistant Staphylococcus aureus (MRSA) occurred in surgical and internal medicine units of a 1752-bed Finnish tertiary care hospital during 2003-2004. In order to analyse the costs of this 14-month outbreak, patients were categorized as follows: patients with MRSA infections; patients with MRSA colonization; patients exposed to MRSA but whose MRSA status remained inconclusive; and exposed patients who were negative for MRSA. We reviewed a sample of patients' charts to determine the types of clinical infections and interviewed staff about the practical implementation of control measures. The number of patients and patient-days involved in the outbreak were identified from the hospital's databases, with the administrative database supplying unit costs of work and materials. Loss of income due to closed beds was analysed. A total of 266 MRSA-positive patients (114 with infections and 152 colonized) and 797 patients exposed to MRSA were identified (11,744 contact isolation days). There were 1240 patients negative after screening (9880 contact isolation days). Total additional costs of MRSA were 386,062 euro (70% for screening and 25% for contact isolation). Costs due to meticillin resistance in treatment of MRSA infections were 16,000 euro. The income loss for this hospital due to closed beds was 1,183,808 euro. The high cost of MRSA screening underlines the importance of appropriate screening methods. Our model of analysing costs might be useful for other hospitals after adapting variables such as local control measures.
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Affiliation(s)
- M Kanerva
- National Public Health Institute, Department of Infectious Disease Epidemiology, Finland.
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