Clostridium difficile 027 infection in Central Italy

Area of Science:

• Infectious Diseases
• Epidemiology
• Microbiology

Background:

• Clostridium difficile (CD) is a significant international health burden, often linked to healthcare environments.
• The emergence of a hypervirulent strain, CD 027, has coincided with increased CD incidence.
• This study reports 10 new cases of CD 027 infection in Italy, following an initial report of 8 cases in 2010.

Purpose of the Study:

• To describe new cases of Clostridium difficile 027 infection in Italy.
• To analyze the clinical, epidemiological, and laboratory data of patients with CD 027 infection.
• To highlight the emergence and risks associated with the CD 027 strain in healthcare settings.

Main Methods:

• Stool samples from patients with severe diarrhea and suspected hypervirulent CD strains were tested using the Xpert C. difficile PCR assay.
• Clinical, epidemiological, and laboratory data were collected for analysis.
• Comparison of CD 027 cases with non-027 CD cases was performed.

Main Results:

• From December 2010 to April 2012, 19 patients with suspected CD 027 were identified across 7 hospitals.
• Of 17 positive PCR tests for CD, 10 (59%) were the epidemic 027 strain.
• Nine of 10 CD 027 patients had healthcare-associated risk factors, including antimicrobial exposure and long-term care facility (LTCF) admission; 50% experienced relapses.
• Non-027 CDAD patients lacked LTCF history and did not experience relapses (p=0.04).

Conclusions:

• Clostridium difficile 027 is emerging in Italian healthcare facilities, with nosocomial acquisition being the primary route.
• A history of recent LTCF stay was noted in 40% of CD 027 patients.
• The high transmissibility and relapse rates of CD 027 pose a substantial risk to healthcare and social care systems in Italy.