Eyre, DW;
Shaw, R;
Adams, H;
Cooper, T;
Crook, DW;
Griffin, R-M;
Mannion, P;
... Craine, N; + view all
(2019)
Whole-genome sequencing to determine the extent of Clostridium difficile transmission in a high incidence setting in North Wales in 2015.
Journal of Antimicrobial Chemotherapy
, 74
(4)
pp. 1092-1100.
10.1093/jac/dky523.
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Abstract
OBJECTIVES: Rates of C. difficile infection (CDI) are higher in North Wales than elsewhere in the UK. We used whole-genome sequencing to investigate if this is due to increased healthcare-associated transmission from other cases. METHODS: Healthcare and community C. difficile isolates from patients across North Wales (February-July-2015) from glutamate dehydrogenase (GDH)-positive faecal samples underwent WGS. Data from patient records, hospital management systems, and national antimicrobial use surveillance were used. RESULTS: 338/499(68%) GDH-positive samples were sequenced, and 299 distinct infections/colonisations identified, 229/299(77%) with toxin genes. Only 39/229(17%) toxigenic isolates were related within ≤2 SNPs to ≥1 infection/colonisation from a previously sampled patient, i.e. demonstrated evidence of possible transmission. Independent predictors of possible transmission included healthcare exposure in the last 12 weeks (p=0.002, with varying rates by hospital), infection with multilocus sequence types ST-1 (ribotype-027) and ST-11 (predominantly ribotype-078) compared to all other toxigenic STs (p<0.001), and cephalosporin exposure in the potential transmission recipient (p=0.02). Adjusting for all these factors, there was no additional effect of ward workload (p=0.54), or failure to meet cleaning targets (p=0.25). Use of antimicrobials is higher in North Wales compared to England and the rest of Wales. CONCLUSIONS: Levels of transmission detected by WGS were comparable to previously described rates in endemic settings; other explanations, such as variations in antimicrobial use, are required to explain the high levels of CDI. Cephalosporins are a risk factor for infection with C. difficile by another infected or colonised case.
| Type: | Article |
|---|---|
| Title: | Whole-genome sequencing to determine the extent of Clostridium difficile transmission in a high incidence setting in North Wales in 2015 |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/jac/dky523 |
| Publisher version: | https://doi.org/10.1093/jac/dky523 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10061773 |
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