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PTH-077 The Changing Face of Clostridium Difficile Infection
  1. N M Joshi1,
  2. J Seale2,
  3. S Das2
  1. 1Centre for Digestive Diseases, Barts and The London School of Medicine and Dentistry
  2. 2Department of Medical Microbiology, Barts Health NHS trust, London, UK

Abstract

Introduction C.difficile infection (CDI) is the most common identified cause of antibiotic associated diarrhoea and carries a significant mortality. Several reports have demonstrated that exogenous infection plays an important role in the spread of CDI. Reports show that ribotype 027 has been responsible for large outbreaks of CDI and is associated with a poorer outcome.

Methods All cases of CDI over a 9 month period (ending August 2012) were cultured and typed by the London reference laboratory. For each case, retrospective data on patient demographics, admission dates, ward and clinical team were analysed.

Results 32 new cases of CDI occurred of which 22(69%) could be ribotyped. All cases had had antibiotic exposure. Average age: 67 years, 27% of cases were from patients admitted to critical care and 13% were under elderly care. 27% of all cases were community and 73% hospital acquired. 12 ribotypes were seen (table 1), 1 case of type 027. There were no cases of CDI of the same ribotype originating in the same clinical area or under the care of the same clinical team within 30 days of each other. 1 patient (ribotype 015) underwent colectomy for colonic perforation secondary to extensive pseudomembranous colitis with co-existing diverticular disease. There was 16% overall mortality on index admission with 1 death indirectly attributable to CDI (ribotype 020).

Abstract PTH-077 Table 1

No predominating ribotype was seen, 1 case of type 027

Conclusion In contrast to previous literature, type 027 was not the predominant ribotype seen in our cohort. The case requiring colectomy was type 015 and the death indirectly attributed to CDI was also not caused by type 027. This demonstrates a possible shift in the epidemiology of CDI. The groups most at risk were patients admitted to critical care and those under the care of the elderly care physicians with an overall 16% mortality whilst still admitted. There was little evidence of cross-infection and most cases were endogenously acquired indicating that infection prevention and control methods being practised at our Trust are effective. These findings also suggest that the main cause of CDI in this study arises from selection pressure secondary to antimicrobial use and emphasises the importance of antibiotic stewardship in the prevention and control of this infection.

Disclosure of Interest None Declared.

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