Changing epidemiology of clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in England

M. H. Wilcox*, Nandini Shetty, W. N. Fawley, M. Shemko, P. Coen, A. Birtles, M. Cairns, Martin Curran, K. J. Dodgson, S. M. Green, K. J. Hardy, P. M. Hawkey, J. G. Magee, A. D. Sails, M. W.D. Wren

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

194 Citations (Scopus)

Abstract

Background. Marked increases in Clostridium difficile infection (CDI) incidence, driven by epidemic strain spread, is a global phenomenon. Methods. The Clostridium difficile Ribotyping Network (CDRN) was established in 2007 as part of enhanced CDI surveillance in England, to facilitate the recognition and control of epidemic strains. We report on changes in CDI epidemiology in England in the first 3 years of CDRN.Results.CDRN received 12 603 fecal specimens, comprising significantly (P <. 05) increasing numbers and proportions of national CDI cases in 2007-2008 (n = 2109, 3.8), 2008-2009 (n = 4774, 13.2), and 2009-2010 (n = 5720, 22.3). The C. difficile recovery rate was 90, yielding 11 294 isolates for ribotyping. Rates of 9 of the 10 most common ribotypes changed significantly (P <. 05) during 2007-2010. Clostridium difficile ribotype 027 predominated, but decreased markedly from 55 to 36 and 21 in 2007-2008, 2008-2009, and 2009-2010, respectively. The largest regional variations in prevalence occurred for ribotypes 027, 002, 015, and 078. Cephalosporin and fluoroquinolone use in CDI cases was reported significantly (P <. 05) less frequently during 2007-2010. Mortality data were subject to potential reporting bias, but there was a significant decrease in CDI-associated deaths during 2007-2010, which may have been due to multiple factors, including reduced prevalence of ribotype 027.Conclusions.Access to C. difficile ribotyping was associated with significant changes in the prevalence of epidemic strains, especially ribotype 027. These changes coincided with markedly reduced CDI incidence and related mortality in England. CDI control programs should include prospective access to C. difficile typing and analysis of risk factors for CDI and outcomes.

Original languageEnglish
Pages (from-to)1056-1063
Number of pages8
JournalClinical Infectious Diseases
Volume55
Issue number8
DOIs
Publication statusPublished - 15 Oct 2012

Bibliographical note

Funding Information:
(CDRN) is funded by the Health Protection Agency. We thank all the laboratory staff in participating CDRN laboratories and the infection prevention and control staff in hospitals in England.

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