Prevalence of the Hypervirulent NAP1/BI/027 Strain of C. Difficile in Southwestern Virginia and Risk Factors Associated with Infection

Author ORCID Identifier

Document Type

Clinical Science Research

Date of Poster


Date of Submission

June 2020


C. difficile infection (CDI) incidence has increased over the last several decades. The BI/NAP1/027 ribotype was discovered in 2005 and has since been responsible for multiple outbreaks in the US and Canada. This subtype of C. Difficile is known to be more virulent in vivo and produce more severe disease. Limited regional data of the prevalence of this ribotype is available, which could help guide treatment. Using infection control data from a large regional hospital and a VA medical center, this study documented the prevalence of the 027 ribotype in Southwest Virginia. Patients were included if they were tested at either of these clinical sites from January 1st, 2017 to August 31st, 2018 and were found to be positive for CDI using the National Healthcare Safety Network LabID event definitions. PCR testing was performed using the Cepeheid Xpert Machine. Of 1468 index cases tested for CDI, 643 PCR tests were performed to test for the presence of C. Difficile toxin when there was a discordance between the Glutamate dehydrogenase (GDH) and toxin immunoassay. 152 of 643 PCR samples (23.6%) were positive for the 027 ribotype, in line with previous estimates in North America and the region. Patients who were found to have the 027 ribotype were more often male, older than age 50, admitted from a skilled nursing facility (SNF), or had community onset with recent healthcare exposure. Patients were more likely to have a stay in the ICU, be discharged as expired or to a SNF, and have a longer length of stay (all P values <0.05). These results can help guide infection control measures targeting these populations, as well as inform antibiotic prescribing decisions and the use of PCR testing in diagnosis.


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