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Hospital outbreak due to Clostridium difficile ribotype 018 (RT018) in Southern Germany

Berger, Fabian K. and Gfrörer, Sabine and Becker, Sören L. and Baldan, Rossella and Cirillo, Daniela Maria and Frentrup, Martinique and Steglich, Matthias and Engling, Pit and Nübel, Ulrich and Mellmann, Alexander and Bischoff, Markus and Gärtner, Barbara and von Müller, Lutz. (2019) Hospital outbreak due to Clostridium difficile ribotype 018 (RT018) in Southern Germany. International journal of medical microbiology : IJMM, 309 (3-4). pp. 189-193.

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Official URL: https://edoc.unibas.ch/70904/

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Abstract

Clostridium (Clostridioides) difficile is the main cause of nosocomial diarrhoea. Ribotype 018 (RT018) has been recognized as the predominant strain responsible for C. difficile infection (CDI) in Italy, whereas in most other European countries only sporadic RT018 cases occur. Between August and October 2015, a suspected C. difficile outbreak at two associated hospitals in Southern Germany was investigated by comprehensive molecular typing. Surprisingly, RT018 was detected in 9/82 CDI patients, which has never been described before in a German outbreak. Phenotypic analysis revealed fluoroquinolone and macrolide resistance. Genetic subtyping using multiple-locus variable-number tandem-repeat analysis (MLVA) and whole genome sequencing (WGS) was performed and outbreak isolates were directly compared to sporadic German RT018 isolates and to epidemic ones from Milan, Northern Italy. Molecular typing confirmed a hospital outbreak with closely related RT018 isolates. Both, MLVA and WGS revealed high similarity of outbreak strains with epidemic isolates from Italy, but low similarity to other German isolates. Comparison between both typing strategies showed that ribotyping in combination with MLVA was appropriate to identify related isolates and clonal complexes, whereas WGS provided a better discrimination with more detailed information about the phylogenetic relationship of isolates. This is the first hospital outbreak in Germany presumably caused by cross-national transmission of an Italian epidemic RT018 strain.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Chronic Disease Epidemiology > Genetic Epidemiology of Non-Communicable Diseases (Probst-Hensch)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin > Genetic Epidemiology of Non-Communicable Diseases (Probst-Hensch)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Becker, Sören Leif
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:ELsevier
ISSN:1618-0607
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:10 Jul 2019 12:30
Deposited On:10 Jul 2019 12:30

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