Successful management of a Clostridioides difficile ribotype 027 outbreak with a lean intervention bundle

Area of Science:

• Infectious Diseases
• Epidemiology
• Microbiology

Background:

• A hypervirulent Clostridioides difficile (C. diff) 027 ribotype was previously absent in Swiss healthcare settings.
• In late 2016, a C. diff infection (CDI) outbreak involving ribotype 027 emerged across multiple hospitals within a network.

Purpose of the Study:

• To investigate an outbreak of Clostridioides difficile infection (CDI) caused by the hypervirulent ribotype 027.
• To identify the outbreak strains and understand transmission dynamics using whole genome sequencing (WGS).

Main Methods:

• Conducted an outbreak investigation following the initial detection of CDI cases.
• Utilized whole genome sequencing (WGS) to confirm the clonality of the C. difficile 027 strains.
• Monitored patient commonalities, including hospitalization, healthcare worker contact, and shared facilities.

Main Results:

• Twenty-eight patients were diagnosed with CDI due to ribotype 027 between December 2016 and December 2017.
• A single clone of C. difficile 027 was responsible for 20 of the cases, indicating clonal transmission.
• Epidemiological links and WGS confirmed transmission pathways, and the outbreak was successfully contained using isolation, awareness, standardized diagnostics, and sporicidal disinfection.

Conclusions:

• The C. difficile 027 outbreak was initially missed due to inconsistent screening, emphasizing the need for better surveillance.
• Effective containment was achieved through rapid implementation of basic infection prevention strategies.
• Standardizing diagnostic approaches, making CDI notifiable, and collecting longitudinal ribotype data are crucial for future C. difficile epidemiology understanding.