MedicalResearch.com Interview with:
David W. Eyre, B.M., B.Ch.
Nuffield Department of Clinical Medicine
University of Oxford
National Institute for Health Research (NIHR) Oxford Biomedical Research Centre
John Radcliffe Hospital
MedicalResearch.com: What are the main findings of this study?
Dr. Eyre: All cases of Clostridium difficile in Oxfordshire were studied over 3 years. Isolates were characterized by whole genome sequencing and the data was linked to hospital databases allowing epidemiological relationships between patients at the level of the hospital ward, hospital specialty, and post code to be identified. For comparison, similar information was also available for all other patients with and without diarrhea. Preliminary work on the genetic diversity of Clostridium difficile within individuals and between individuals within discrete outbreaks allowed reliable interpretation of transmission events using genomic data.
This allowed a complete reconstruction of the pattern of transmission between affected cases in Oxfordshire to be made.
The findings were:
1. Unexpectedly few cases (13%) appear to be acquired from direct ward based contact with other symptomatic cases (these have previously been thought to be the main source of infections, and the focus of prevention efforts). Another 6% were associated with other hospital contact and 3% had plausible community contacts.
2. In 13% of cases potential donors were identified gnomically but no contact, within hospitals or the community, were identified. This suggests that the existence of other modes of transmission of Clostridium difficile.
3. The sources of Clostridium difficile infections were highly genetically diverse, with 45% of cases having a genetically distinct origin – suggesting a diverse reservoir of disease, not previously appreciated
4. During the 3 years of the study the rate of Clostridium difficile in Oxfordshire fell. Any improvement in infection control techniques would be expected to reduce the incidence of cases caused by within hospital transmission. Surprisingly, similar rates of fall occurred in both in secondary cases (considered to be acquired from hospital associated symptomatic cases) and for primary cases (cases not associated with transmission from symptomatic cases).