Highly virulent C. difficile detected in Australia

[Wishart, Michael]

[Posted on behalf of Claire Boardman, AICA President – Moderator]

Dear PHSC Member,

I am writing to you to inform you that at today’s meeting of the Commission’s HAI Advisory Committee it was reported by one of the members that a hospital case of highly virulent (NAP1/027) strain of Clostridium difficile infection had been detected with probable transmission to other patients within that facility. You may be aware of this through your usual infectious diseases channels.
The emergence of C. difficile (NAP1/027) in North America and Europe has been associated with increased frequency, severity and relapse of C. difficile infection as well as a significant increase in mortality and morbidity.
As you will recall in December 2008 Australian Health Ministers endorsed a recommendation that all hospitals monitor and report through their relevant jurisdiction into a national data collection C. difficile infections.
The reasons for inclusion for monitoring were that C. difficile infection:
*is a common HAI infection that causes significant patient morbidity and mortality for already infected patients in hospitals and long term care facilities.
*there has been an inconsistent approach to its prevention, identification and management in Australia
*local capacity to detect and respond to virulent strain emergence is limited because of the absence of co-ordinated surveillance
*the early detection of highly virulent strains of C. difficile infection in Australia, will enable early interventions to prevent major harm to Australian patients.
As a consequence of the Health Ministers endorsement, the Commission developed a recommended surveillance approach within a data dictionary for HAI Infection that was circulated to Heads of Jurisdictional Departments of Health (and copied to Inter-jurisdictional Committee Members) by the Commission in December 2009 (see web link below).
Effective antimicrobial stewardship, Standard Precautions including hand washing, environmental cleaning and disinfection and additional contact isolation precautions are the key prevention and control measures for C. difficile infection.
Advice from the Commission’s HAI Advisory Committee is that specimens and/or C. difficile isolates from patients displaying criteria of severe disease (below) should be referred to a specialised reference laboratory for identification and typing as soon as practicable.
If you were not aware of this case, you may care to consider the implications for your own C. difficile infection surveillance.
The Commission has advised the Commonwealth Chief Medical Officer of this situation.
Yours sincerely
Professor Chris Baggoley
Chief Executive
20 May 2010

Severe C. difficile Infection
Severe disease should be considered in the following setting, if combinations of these findings are present in the presence of C difficile infection.*age >60 years,
*temperature >38.3C,
*serum albumin 15,000 cells/microL
*deteriorating renal function
*elevated serum lactate
*endoscopic evidence of pseudomembranous colitis or treatment in the intensive care unit
*subtotal colectomy performed.
*toxic megacolon diagnosed

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/8ACDDE1B8F648482CA2573AF007BC2D4/$File/DDC-Guidelines-HAI.pdf
The putative international standard of practice is now the Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). This is available via http://www.journals.uchicago.edu/doi/full/10.1086/651706 .

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[Louise Davis]

Hello,

Thanks for passing this information on.
Does anyone else think that this is too broad a collection of findings
of which any are to be considered pointers of severe disease?
The statement implies that any combination of the findings listed
should lead one to consider severe disease in the presence of
C.difficile infection?
I suspect that this will wave too broad a brush and needs to be refined
to specific combinations of these findings.
kind regards

Louise Davis
Microbiologist
Queensland

>>> “Wishart, Michael” 20/05/2010 5:18
pm >>>
[Posted on behalf of Claire Boardman, AICA President – Moderator]

Dear PHSC Member,

I am writing to you to inform you that at today’s meeting of the
Commission’s HAI Advisory Committee it was reported by one of the
members that a hospital case of highly virulent (NAP1/027) strain of
Clostridium difficile infection had been detected with probable
transmission to other patients within that facility. You may be aware of
this through your usual infectious diseases channels.
The emergence of C. difficile (NAP1/027) in North America and Europe
has been associated with increased frequency, severity and relapse of C.
difficile infection as well as a significant increase in mortality and
morbidity.
As you will recall in December 2008 Australian Health Ministers
endorsed a recommendation that all hospitals monitor and report through
their relevant jurisdiction into a national data collection C. difficile
infections.
The reasons for inclusion for monitoring were that C. difficile
infection:
*is a common HAI infection that causes significant patient morbidity
and mortality for already infected patients in hospitals and long term
care facilities.
*there has been an inconsistent approach to its prevention,
identification and management in Australia
*local capacity to detect and respond to virulent strain emergence is
limited because of the absence of co-ordinated surveillance
*the early detection of highly virulent strains of C. difficile
infection in Australia, will enable early interventions to prevent major
harm to Australian patients.
As a consequence of the Health Ministers endorsement, the Commission
developed a recommended surveillance approach within a data dictionary
for HAI Infection that was circulated to Heads of Jurisdictional
Departments of Health (and copied to Inter-jurisdictional Committee
Members) by the Commission in December 2009 (see web link below).
Effective antimicrobial stewardship, Standard Precautions including
hand washing, environmental cleaning and disinfection and additional
contact isolation precautions are the key prevention and control
measures for C. difficile infection.
Advice from the Commission’s HAI Advisory Committee is that specimens
and/or C. difficile isolates from patients displaying criteria of severe
disease (below) should be referred to a specialised reference laboratory
for identification and typing as soon as practicable.
If you were not aware of this case, you may care to consider the
implications for your own C. difficile infection surveillance.
The Commission has advised the Commonwealth Chief Medical Officer of
this situation.
Yours sincerely

Professor Chris Baggoley
Chief Executive
20 May 2010

Severe C. difficile Infection
Severe disease should be considered in the following setting, if
combinations of these findings are present in the presence of C
difficile infection.
*age >60 years,
*temperature >38.3C,
*serum albumin 15,000 cells/microL
*deteriorating renal function
*elevated serum lactate
*endoscopic evidence of pseudomembranous colitis or treatment in the
intensive care unit
*subtotal colectomy performed.
*toxic megacolon diagnosed

http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/8ACDDE1B8F648482CA2573AF007BC2D4/$File/DDC-Guidelines-HAI.pdf

The putative international standard of practice is now the Clinical
Practice Guidelines for Clostridium difficile Infection in Adults: 2010
Update by the Society for Healthcare Epidemiology of America (SHEA) and
the Infectious Diseases Society of America (IDSA). This is available via
http://www.journals.uchicago.edu/doi/full/10.1086/651706 .

This e-mail message and any accompanying files may contain
information that is confidential and subject to privilege. If you
are not the intended recipient, and have received the e-mail
in error, you are notified that any use, dissemination,
distribution, forwarding, printing or copying of the message
and any attached files is strictly prohibited. If you have
received this e-mail message in error please immediately
advise the sender by return e-mail, or telephone 1800 243 903.
You must destroy the original transmission and its contents.
Any views expressed within this communication are those of
the individual sender, except where the sender specifically
states them to be the views of Ramsay Health Care.
This communication should not be copied or disseminated
without permission.
————————————————————————

Messages posted to this list are solely the opinion of the authors, and
do not represent the opinion of AICA.
Archive of all messages are available at
http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a
new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to
aicalist-request@aicalist.org.au.
You can unsubscribe from this list be sending ‘signoff aicalist’
(without the quotes) to listserv@aicalist.org.au

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Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of AICA.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
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