[AVX Seminar] Mónica Oleastro
Mónica Oleastro, Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| When |
20 Nov, 2014
from
11:00 am to 12:00 pm |
|---|---|
| Where | Auditorium |
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AVX Seminar
Title: Prevalence and epidemiology of Clostridium difficile infection in Portugal: where do we stand?
Speaker: Mónica Oleastro
Affiliation: Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
Abstract: Clostridium difficile Infection (CDI), an infection of the large intestine, is the leading cause of healthcare-associated diarrhea in Europe. CDI is usually a consequence of antibiotic use and most cases occur in the elderly. CDI symptoms range from mild, self-limiting diarrhea, to severe, life-threatening bowel complications such as toxic megacolon and pseudo membranous colitis. CDI is common is hospitals and is increasingly recognized by experts as a problem in the community.
CDI infection has gained recognition as a serious health problem due to the dissemination of an epidemic clone (belonging to ribotype 027), which spread all over the world, being originated from Canada and USA. Since 2003, this clone was responsible for large outbreaks of CDI, characterized by more severe cases, high recurrence rates and high rates of mortality.
This epidemic strain was characterized by higher than usual toxin A and B production, the presence of a third toxin, binary toxin, and high-level resistance to fluoroquinolone antibiotics.
We speculate that this strain arrived in Portugal around 2006-07, associated with an exponential increase in CDI cases in several hospital facilities and also with the occurrence of outbreaks with high mortality rates.
Our surveillance data of CDI in Portugal strongly suggests that it is an under-diagnosed infection, whose prevalence may be 6 times higher than suspected. We have also observed a high genetic diversity of strains circulating in our hospitals, suggesting different sources of infection, although the most commonly found strain was the epidemic clone 027. A high level of resistance to antibiotics usually used for the treatment of CDI and to agents that are implicated in selection pressure was also observed among the most common circulating strains. In addition these strains showed higher CMIs to some antibiotics, than the less frequent strains, likely associated with higher dissemination capacity and higher resistance to antibiotic therapy.
