Clinical and Molecular Characteristics of an Outbreak Caused by the Pandemic (BI/NAP1/027) Clostridium difficile Clone in a Single Center in Israel

Abstract

This study aimed to analyse the clinical and epidemiological characteristics of Clostridium difficile infection (CDI) at the Shaare Zedek Medical Center in Jerusalem, Israel, and to explore the clonal structure and antimicrobial susceptibility patterns of the respective C. difficile isolates. Between February and September 2013, all consecutive nonduplicate samples of adult patients from all of the hospital's wards with first-episode CDI were included in the study. A total of 61 toxigenic C. difficile isolates were analysed; 48 (79%) belonged to the epidemic slpA-type gc8 strain (inferred ribotype 027). Resistance to moxifloxacin was present in all gc8 isolates vs. 3 (27%) of the non-gc8 isolates (P<0.001). Resistance to vancomycin and metronidazole was not found. CDI patients infected with the epidemic slpA-type gc8 strain were more likely to have excessive leukocytosis than patients infected with other strains. Mortality rate was high in both groups and was higher in the gc8 strain group (43% vs. 27% for other strains), but the difference was not statistically significant. This is believed to be the first outbreak caused by the epidemic ribotype 027 reported from the Middle East and one of the few reported outside Europe and North America.