Outbreak of Clostridioides difficile infection in Silesian district hospital
More details
Hide details
Department of Medical Microbiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland / Katedra i Zakład Mikrobiologii Lekarskiej, Wydział Nauk Medycznych w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Student Research Group, Department of Medical Microbiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland / Studenckie Koło Naukowe przy Katedrze i Zakładzie Mikrobiologii Lekarskiej, Wydział Nauk Medycznych w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Department of Microbiology, KORLAB Medical Laboratory, Ruda Śląska, Poland / Pracownia Mikrobiologii, KORLAB Laboratoria Medyczne, Ruda Śląska
Corresponding author
Klaudia T. Szarek   

Katedra i Zakład Mikrobiologii Lekarskiej, Wydział Nauk Medycznych w Katowicach, Śląski Uniwersytet Medyczny w Katowicach, ul. Medyków 18, 40-752 Katowice
Ann. Acad. Med. Siles. 2023;77:75-81
In order to evaluate a Clostridioides difficile infection (CDI) outbreak between December 2018 and February 2019 in the internal medicine ward of a district hospital in Silesia, 6 stools from 5 patients were examined.

Material and methods:
C. difficile was identified, genes encoding glutamate dehydrogenase (GDH) – gluD, A/B – tcdA/tcdB and binary – cdtA/cdtB toxins, ermB were determined by mPCR and antibiotic resistance by means of E-Tests.

Women predominated among the patients (4/5). All the 6 C. difficile isolates belonged to hyperepidemic ribotype 027, were positive for all genes and were resistant to moxifloxacin, erythromycin, clindamycin, rifampicin, imipenem, and chloramphenicol.

The obtained results indicate that the hyperepidemic C. difficile clone is spreading in the ward.

The authors gratefully acknowledge Prof. Ed Kuijper and Dr Celine Harmanus (Department Of Microbiology, Leiden University Medical Center, The Netherlands) for the C. difficile ribotyping.
This study was financed by a grant from the Medical University of Silesia no. PCN-1-126/K/0/I.
Undeclared conflict of interest.
Stan Sanitarny Kraju w 2020 roku [pdf]. Główny Inspektorat Sanitarny. Warszawa, sierpień 2021 r. [online] https://www.gov.pl/web/gis/sta... [accessed on 20 June 2021].
Marra A.R., Perencevich E.N., Nelson R.E., Samore M., Khader K., Chiang H.Y. et al. Incidence and outcomes associated with Clostridium difficile infections: a systematic review and meta-analysis. JAMA Netw. Open 2020; 3(1): e1917597, doi: 10.1001/jamanetworkopen.2019.17597.
Lewandowski K., Rosołowski M., Kaniewska M., Kucha P., Meler A., Wierzba W., Rydzewska G. Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem? Pol. Arch. Intern Med. 2021; 131(2): 121–127, doi: 10.20452/pamw.15715.
Czepiel J., Dróżdż M., Pituch H., Kuijper E.J., Perucki W., Mielimonka A. et al. Clostridium difficile infection: review. Eur. J. Clin. Microbiol. Infect. Dis. 2019; 38(7): 1211–1221, doi: 10.1007/s10096-019-03539-6.
Aptekorz M., Szczegielniak A., Wiechuła B., Harmanus C., Kuijper E., Martirosian G. Occurrence of Clostridium difficile ribotype 027 in hospitals of Silesia, Poland. Anaerobe 2017; 45: 106–113, doi: 10.1016/j.anaerobe.2017.02.002.
Kabała M., Gofron Z., Aptekorz M., Sacha K., Harmanus C., Kuijper E. et al. Clostridioides difficile ribotype 027 (RT027) outbreak investigation due to the emergence of rifampicin resistance using multilocus variable-number tandem repeat analysis (MLVA). Infect. Drug Resist. 2021; 14: 3247–3254, doi: 10.2147/IDR.S324745.
Davies K.A., Ashwin H., Longshaw C.M., Burns D.A., Davis G.L., Wilcox M.H. et al. Diversity of Clostridium difficile PCR ribotypes in Europe: results from the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID), 2012 and 2013. Euro. Surveill. 2016; 21(29), doi: 10.2807/1560-7917.ES.2016.21.29.30294.
Collins D.A., Riley T.V. Clostridium difficile Guidelines. Clin. Infect. Dis. 2018; 67(10): 1639, doi: 10.1093/cid/ciy249.
Lachowicz D., Pituch H., Wultańska D., Kuijper E., Obuch-Woszczatyński P. Surveillance of antimicrobial susceptibilities reveals high proportions of multidrug resistance in toxigenic Clostridium difficile strains in different areas of Poland. Anaerobe 2020; 62: 102167, doi: 10.1016/j.anaerobe.2020.102167.
van Prehn J., Reigadas E., Vogelzang E.H., Bouza E., Hristea A., Guery B. et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clin. Microbiol. Infect. 2021; 27(Suppl 2): S1–S21, doi: 10.1016/j.cmi.2021.09.038.
Johnson S., Lavergne V., Skinner A.M., Gonzales-Luna A.J., Garey K.W., Kelly C.P. et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clin. Infect. Dis. 2021; 73(5): e1029–e1044, doi: 10.1093/cid/ciab549.
Clancy C.J., Buehrle D., Vu M., Wagener M.W., Nguyen M.H. Impact of Revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America Clinical Practice Guidelines on the Treatment of Clostridium difficile Infections in the United States. Clin. Infect. Dis. 2021; 72(11): 1944–1949, doi: 10.1093/cid/ciaa484.
Lee H.S., Plechot K., Gohil S., Le J. Clostridium difficile: diagnosis and the consequence of over diagnosis. Infect. Dis. Ther. 2021; 10(2): 687–697, doi: 10.1007/s40121-021-00417-7.
Stubbs S., Rupnik M., Gibert M., Brazier J., Duerden B., Popoff M. Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile. FEMS Microbiol. Lett. 2000; 186(2): 307–312, doi: 10.1111/j.1574-6968.2000.tb09122.x.
Fawley W.N., Knetsch C.W., MacCannell D.R., Harmanus C., Du T., Mulvey M.R. et al. Development and validation of an internationally-standardized, high-resolution capillary gel-based electrophoresis PCR-ribotyping protocol for Clostridium difficile. PLoS One 2015; 10(2): e0118150, doi: 10.1371/journal.pone.0118150.
Clinical breakpoints – bacteria (v10.0) – 2020. EUCAST [online] https://www.eucast.org/clinica... [accessed on 12 December 2021].
Allegretti J.R., Marcus J., Storm M., Sitko J., Kennedy K., Gerber G.K. et al. Clinical predictors of recurrence after primary Clostridioides difficile infection: a prospective cohort study. Dig. Dis. Sci. 2020; 65(6): 1761–1766, doi: 10.1007/s10620-019-05900-3.
Dharbhamulla N., Abdelhady A., Domadia M., Patel S., Gaughan J., Roy S. Risk factors associated with recurrent Clostridium difficile infection. J. Clin. Med. Res. 2019; 11(1): 1–6, doi: 10.14740/jocmr3531w.
Cioni G., Viale P., Frasson S., Cipollini F., Menichetti F., Petrosillo N. et al. Epidemiology and outcome of Clostridium difficile infections in patients hospitalized in Internal Medicine: findings from the nationwide FADOI-PRACTICE study. BMC Infect. Dis. 2016; 16(1): 656, doi: 10.1186/s12879-016-1961-9.
Vernon J.J., Wilcox M.H., Freeman J. Antimicrobial resistance progression in the United Kingdom: A temporal comparison of Clostridioides difficile antimicrobial susceptibilities. Anaerobe 2021; 70: 102385, doi: 10.1016/j.anaerobe.2021.102385.
Pituch H., Obuch-Woszczatyński P., Lachowicz D., Kuthan R., Dzierżanowska-Fangrat K., Mikucka A. et al. Prevalence of Clostridium difficile infection in hospitalized patients with diarrhoea: Results of a Polish multicenter, prospective, biannual point-prevalence study. Adv. Med. Sci. 2018; 63(2): 290–295, doi: 10.1016/j.advms.2018.03.003.
Journals System - logo
Scroll to top