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J Antimicrob Chemother. 2018 Dec 15. doi: 10.1093/jac/dky523. [Epub ahead of print]

WGS to determine the extent of Clostridioides difficile transmission in a high incidence setting in North Wales in 2015.

Author information

1
Big Data Institute, University of Oxford, England, UK.
2
Nuffield Department of Medicine, University of Oxford, England, UK.
3
Betsi Cadwaladr University Health Board, Ysbyty Gwynedd, Bangor, Wales, UK.
4
Betsi Cadwaladr University Health Board, Ysbyty Glan Clwyd, Bangor, Wales, UK.
5
Public Health Wales, Microbiology, Ysbyty Glan Clwyd, Rhyl, Wales, UK.
6
Public Health Wales, Health Protection, Capital Quarter, Cardiff, Wales, UK.
7
Public Health Wales, Microbiology, Heath Hospital, Cardiff, Wales, UK.
8
Public Health Wales, Health Protection, Ysbyty Gwynedd, Bangor, Wales, UK.

Abstract

Objectives:

Rates of Clostridioides (Clostridium) difficile infection (CDI) are higher in North Wales than elsewhere in the UK. We used WGS 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:

Of the 499 GDH-positive samples, 338 (68%) were sequenced and 299 distinct infections/colonizations were identified, 229/299 (77%) with toxin genes. Only 39/229 (17%) toxigenic isolates were related within ≤2 SNPs to ≥1 infections/colonizations 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 rates varying by hospital), infection with MLST types ST-1 (ribotype 027) and ST-11 (predominantly ribotype 078) compared with 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 with 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 from another infected or colonized case.

PMID:
30561656
DOI:
10.1093/jac/dky523

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