Clostridium difficile is the most common cause of antibiotic-associated diarrhoea in hospitals and other healthcare facilities. The elderly are particularly susceptible and at increased risk for adverse outcome as a result of C. difficile infection. The aim of this study was to determine the prevalence of C. difficile colonization among residents of nursing homes in Hesse and to compare it with the prevalence in the general population living outside long-term care facilities (LTCF). We assessed possible risk factors for C. difficile colonization and determined the genotype of circulating strains. C. difficile was isolated from 11/240 (4.6%) nursing home residents and 2/249 (0.8%) individuals living outside LTCF (p = 0.02). Ten of 11 (90.9%) isolates from nursing homes and one of two isolates from the population outside LTCF were toxigenic. The prevalence of C. difficile colonization varied from 0% to 10% between different nursing homes. Facilities with known actual or recent CDI cases were more likely to have colonized residents than facilities without known CDI cases. C. difficile PCR-ribotypes 014 and 001 were the most prevalent genotypes and accounted for 30% and 20% of toxigenic isolates in nursing homes, respectively. Interestingly, no individuals carried the epidemic strain PCR-ribotype 027. Our results suggest that residents of nursing homes in Germany are at high risk for colonization by virulent C. difficile strains. The high prevalence of C. difficile colonization in nursing homes underscores the importance of good adherence to standard infection control precautions even in the absence of a diagnosed infection. They also emphasize the need for specific programs to increase the awareness of healthcare professionals in LTCF for CDI.
References
[1]
Rupnik M, Wilcox MH, Gerding DN (2009) Clostridium difficile infection: new developments in epidemiology and pathogenesis. Nat Rev Microbiol 7: 526–536.
[2]
Freeman J, Bauer MP, Baines SD, Corver J, Fawley WN, et al. (2010) The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 23: 529–549.
[3]
Henrich TJ, Krakower D, Bitton A, Yokoe DS (2009) Clinical risk factors for severe Clostridium difficile-associated disease. Emerg Infect Dis 15: 415–422.
[4]
Simor AE, Bradley SF, Strausbaugh LJ, Crossley K, Nicolle LE (2002) Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 23: 696–703.
[5]
Hensgens MP, Goorhuis A, Notermans DW, van Benthem BH, Kuijper EJ (2010) [Changing epidemiology of infections in the Netherlands in 2008/′09]. Ned Tijdschr Geneeskd 2010.
[6]
Birgand G, Blanckaert K, Carbonne A, Coignard B, Barbut F, et al. (2010) Investigation of a large outbreak of Clostridium difficile PCR-ribotype 027 infections in northern France, 2006–2007 and associated clusters in 2008–2009. Euro Surveill 15(25): 19597.
[7]
Burns K, Morris-Downes M, Fawley WN, Smyth E, Wilcox MH, et al. (2010) Infection due to C. difficile ribotype 078: first report of cases in the Republic of Ireland. J Hosp Infect 75: 287–291. Epub 2010 Jun 2017.
[8]
Crogan NL, Evans BC (2007) Clostridium difficile: an emerging epidemic in nursing homes. Geriatr Nurs 28: 161–164.
[9]
Simor AE, Yake SL, Tsimidis K (1993) Infection due to Clostridium difficile among elderly residents of a long-term-care facility. Clin Infect Dis 17: 672–678.
[10]
Campbell RJ, Giljahn L, Machesky K, Cibulskas-White K, Lane LM, et al. (2009) Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 30: 526–533.
[11]
Aronsson B, Mollby R, Nord CE (1985) Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980–1982. J Infect Dis 151: 476–481.
[12]
Gaynes R, Rimland D, Killum E, Lowery HK, Johnson TM 2nd, et al. (2004) Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 38: 640–645.
[13]
Gerding DN (2004) Clindamycin, cephalosporins, fluoroquinolones, and Clostridium difficile-associated diarrhea: this is an antimicrobial resistance problem. Clin Infect Dis 38: 646–648.
[14]
Hensgens MP, Goorhuis A, van Kinschot CM, Crobach MJ, Harmanus C, et al. (2011) Clostridium difficile infection in an endemic setting in the Netherlands. Eur J Clin Microbiol Infect Dis 30: 587–593. Epub 2010 Dec 2031.
[15]
Campbell RR, Beere D, Wilcock GK, Brown EM (1988) Clostridium difficile in acute and long-stay elderly patients. Age Ageing 17: 333–336.
[16]
Miyajima F, Roberts P, Swale A, Price V, Jones M, et al. (2011) Characterisation and Carriage Ratio of Clostridium difficile Strains Isolated from a Community-Dwelling Elderly Population in the United Kingdom. PLoS ONE 6: e22804.
[17]
Sethi AK, Al-Nassir WN, Nerandzic MM, Bobulsky GS, Donskey CJ (2010) Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect 31: 21–27.
[18]
Garey KW, Sethi S, Yadav Y, DuPont HL (2008) Meta-analysis to assess risk factors for recurrent Clostridium difficile infection. J Hosp Infect 70: 298–304. Epub 2008 Oct 2031.
[19]
Zaiss NH, Witte W, Nubel U (2010) Fluoroquinolone resistance and Clostridium difficile, Germany. Emerg Infect Dis 16: 675–677.
[20]
Bauer MP, Notermans DW, van Benthem BH, Brazier JS, Wilcox MH, et al. (2011) Clostridium difficile infection in Europe: a hospital-based survey. Lancet 377: 63–73.
[21]
Arvand M, Hauri AM, Zaiss NH, Witte W, Bettge-Weller G (2009) Clostridium difficile ribotypes 001, 017, and 027 are associated with lethal C. difficile infection in Hesse, Germany. Euro Surveill 14: 19403.
[22]
Arvand M, Hauri AM, Zaiss NH, Witte W, Bettge-Weller G (2010) [Epidemiology of severe Clostridium difficile infections in Hesse, Germany in 2008–2009]. Dtsch Med Wochenschr 135: 1963–1967.
[23]
Borgmann S, Kist M, Jakobiak T, Reil M, Scholz E, et al. (2008) Increased number of Clostridium difficile infections and prevalence of Clostridium difficile PCR ribotype 001 in southern Germany. Euro Surveill 13: 19057.
[24]
Bidet P, Barbut F, Lalande V, Burghoffer B, Petit JC (1999) Development of a new PCR-ribotyping method for Clostridium difficile based on ribosomal RNA gene sequencing. FEMS Microbiol Lett 175: 261–266.
