Nosocomial transmission of Clostridium difficile ribotype 027 in a Chinese hospital, 2012-2014, traced by whole genome sequencing.

Hongbing Jia,Yongtong Cao,Pengcheng Du,Ying Cheng,Wen Zhang,Jing Zhang,Na Han,Chen Chen,Haiyin Wang,Yujun Qiang,Frédéric Barbut,Jing Wang,Qingming Ding,Guiling Han,Zhiyuan Yao,George F Gao,Hui Yang,Yuanyuan Zhang,Zhen Wang

doi:10.1186/s12864-016-2708-0

Abstract

BackgroundThe rapid spread of Clostridium difficile NAP1/BI/027 (C. difficile 027) has become one of the leading threats of healthcare-associated infections worldwide. However, C. difficile 027 infections have been rarely reported in Asia, particularly in China.ResultsIn this study, we identified a rare C. difficile bloodstream infection (BSI) from three isolates of a patient during repeated hospital admission. This finding triggered a retrospective epidemiological study to scan all cases and strains emerged from this ward during the past three years. Using medical personnel interviews, medical record reviews and the genomic epidemiology, two outbreaks in 2012 and 2013–2014 were identified. Through using whole genome sequencing, we succeeded to trace the origin of the BSI strain. Surprisingly, we found the genome sequences were similar to C. difficile 027 strain R20291, indicating the occurrence of a rare C. difficile 027 strain in China. Integrated epidemiological investigation and whole genome sequencing of all strains, we constructed a nosocomial transmission map of these two C. difficile 027 outbreaks and traced the origin of the infection.ConclusionsBy genome sequencing, spatio-temporal analysis and field epidemiology investigation, we can estimate their complex transform network and reveal the possible modes of transmission in this ward. Based on their genetic diversity, we can assume that the toilets, bathroom, and janitor’s equipment room may be contaminated area, which may be suggested to improve infection control measures in the following health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12864-016-2708-0) contains supplementary material, which is available to authorized users.

Highlights

The rapid spread of Clostridium difficile the North American Pulsed-field type one (NAP1)/BI/027 (C. difficile 027) has become one of the leading threats of healthcare-associated infections worldwide
Clostridium difficile is an anaerobic, gram-positive, sporeforming bacterium responsible for infections ranging from mild diarrhea to pseudomembranous colitis, primarily in elderly patients exposed to antibiotics
We report the first NAP1/BI/027 outbreak in a hospital in mainland China, traced by a rare case of bloodstream infection (BSI) using whole genome

Summary

Introduction

The rapid spread of Clostridium difficile NAP1/BI/027 (C. difficile 027) has become one of the leading threats of healthcare-associated infections worldwide. C. difficile 027 infections have been rarely reported in Asia, in China. Clostridium difficile is an anaerobic, gram-positive, sporeforming bacterium responsible for infections ranging from mild diarrhea to pseudomembranous colitis, primarily in elderly patients exposed to antibiotics. This bacterium has become one of the most frequent microorganisms responsible for healthcare-associated infections in the United States [1]. Large outbreaks of NAP1/BI/027 are less reported in Asia and Latin America compared to North America and Europe [6, 7]. To the best of our knowledge, no report of C. difficile infection (CDI) outbreaks in China has been published, and even few of case reported so far in the English literature

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