Abstract
After the first outbreaks of Clostridium difficile PCR ribotype 027 (North American pulsed-field type 1, restriction endonuclease analysis group BI) in the Netherlands in 2005, a national surveillance programme for C. difficile infection (CDI) was started. Furthermore, national guidelines were developed to rapidly recognise type 027 infections and prevent further spread. The mean incidence of CDI measured in 14 hospitals remained stable throughout the years: an incidence of 18 per 10,000 admissions was seen in 2007 and 2008. Between April 2005 and June 2009 a total of 2,788 samples were available for PCR ribotyping. A decrease was seen in the number and incidence of type 027 after the second half of 2006. In the first half of 2009, the percentage of type 027 isolates among all CDI decreased to 3.0%, whereas type 001 increased to 27.5%. Type 014 was present in 9.3% of the isolates and C. difficile type 078 slightly increased to 9.1%. We conclude that currently there is a significant decrease in type 027-associated CDI in the Netherlands.
Highlights
Since the new hypervirulent strain of Clostridium difficile, PCR ribotype 027, North American pulsed-field type 1 (NAP1), restriction endonuclease analysis (REA) group BI, was found in the United States and Canada in 2001, a large number of countries worldwide reported C. difficile infections (CDI) due to this type [1,2]
Soon after the first outbreaks in the Netherlands in 2005, a national surveillance programme for C. difficile was initiated by the Leiden University Medical Centre (LUMC) and the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment
Most hospitals which experienced CDI due to type 027 followed the principles of the infection control guideline supported by the European Centre for Disease Prevention and Control (ECDC) to limit the spread of C. difficile, emphasising the importance of responsible use of antimicrobial drugs in conjunction with proper environmental disinfection, compliance with hand hygiene, protective clothing, education of staff and single-room isolation or cohorting of CDI patients [12,13]
Summary
Infectieziektebestrijding (Centre for Infectious Disease Control; Cib), Bilthoven, the Netherlands. After the first outbreaks of Clostridium difficile PCR ribotype 027 (North American pulsed-field type 1, restriction endonuclease analysis group BI) in the Netherlands in 2005, a national surveillance programme for C. difficile infection (CDI) was started. In the period between April 2005 and June 2009, a total of 3,137 samples were submitted to the reference laboratory, of which 89% (n=2,788) were available for PCR ribotyping Of those 2,788 samples, 51% had been submitted by medical microbiologists because of either severe disease or a CDI outbreak, whereas the remaining 49% were part of the national surveillance study. Since no difference in the distribution of various PCR ribotypes was found between the two surveillance systems, we represent the data combined The reason for this equal distribution is that most hospitals that encountered an outbreak or a case of severe CDI, continued to submit samples on a regular basis thereafter. In the 14 hospitals participating in the continuous surveillance, a Figure C. difficile PCR ribotypes in the Netherlands, April 2005 – June 2009 (n=2,788)
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