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Clostridium difficile infection in cystic fibrosis patients

Mulrennan, S., Tai, A., Eng, L., Putsathit, P., Collins, D. and Riley, T. (2018) Clostridium difficile infection in cystic fibrosis patients. Pediatric Pulmonology, 53 (S2). S393-S393.


Introduction: Risk factors for Clostridium difficile infection (CDI), a common hospital-acquired infection, include recent antimicrobial exposure, hospitalization and advanced age. Patients with a chronic disease such as cystic fibrosis (CF) require multiple courses of antimicrobials, and potentially lung transplantation, meaning they are at high risk of acquiring C. difficile or developing CDI. Recently, there have been cases of severe CDI in CF patients reported in Australia. The objectives of this project were to determine the prevalence of CDI or C. difficile colonisation in CF patients in Western Australia, and to study the molecular epidemiology of C. difficile strains from these patients.

Methods: From late June to December 2017, 24 CF patients who came for treatment or consultation at the Department of Respiratory Medicine at Sir Charles Gairdner Hospital (SCGH) were recruited with informed consent. Faecal samples were collected on this initial visit, and after subsequent visits, and screened for C. difficile and toxins using EIA. All samples were also cultured for C. difficile and any isolates ribotyped and toxin gene profiled. Before the study started, 177 environmental samples were collected from the CF outpatient clinic and inpatient ward with MWE Polywipe sponges which were also cultured for C. difficile.

Results: The prevalence of C. difficile colonisation in CF patients on the initial visit was 46% (11/24), increasing to 54% through the period of study as two patients became positive with C. difficile after antimicrobial treatment. One patient was persistently positive throughout the study. None of these three patients was symptomatic at the time of sample collection although one required CDI therapy within 6 weeks. The prevalence of C. difficile in the environment was 3% (6/177); 1/90 samples from the outpatient clinic and 5/87 samples from the ward. PCR ribotyping revealed 8 distinct ribotypes in patients, with the nontoxigenic strain RT 039 the most common (8 isolates). RT 014/020 (3), RT, 046 (2), RT 103 (1), RT 012 (1), and RT QX 360 (1) were all toxigenic. The nontoxigenic RT 010 comprised 5 of 6 isolates found in the environment, however, this strain was not isolated from patients. Routine surveillance data for C. difficile in non-CF patients revealed that RT 014/020 was the most common ribotype found in WA during the study period. All toxigenic ribotypes found in CF patients were found in non-CF patients.

Discussion: About half the C. difficile strains found in CF patients were toxigenic but no toxin was detected in the faeces of any culture-positive patient, suggesting possible protective effects of the CF intestinal milieu or microbiome. These asymptomatic carriers are however a potential source of C. difficile, and infection prevention and control procedures should be applied appropriately. Further studies should focus on the effect of the CF intestinal microbiome, CFTR mutations and CFTR modulator therapy on the epidemiology of CDI and C. difficile colonisation in CF patients.

Item Type: Journal Article
Murdoch Affiliation(s): School of Veterinary and Life Sciences
Publisher: Wiley-Blackwell
Copyright: © 2018 Wiley Periodicals, Inc.
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