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Clostridium difficile Ribotyping Network (CDRN) Service

C. difficile ribotype with similarity dendrogram

The Health Protection Agency funded this new initiative in England, starting in April 2007. Initially known as CDRNE, the network has since expanded from six to eight laboratories, including one in N. Ireland.  The network was therefore renamed in April 2009 as the Clostridium difficile Ribotyping Network (CDRN) for England and N. Ireland.

CDRN consists of eight participating laboratories:

Leeds (Reference Laboratory, Leeds General Infirmary), Birmingham (Heartlands Hospital), Cambridge (Addenbrooke's Hospital), London (HPA Collaborating Centre at University College Hospital), Manchester (Manchester Royal Infirmary), Newcastle (Newcastle General Hospital) and Southampton (Southampton General Hospital), and Belfast (Royal Victoria Hospital) in N. Ireland.

In 2008/09 CDRN processed 4,682 faecal samples from 190 healthcare facilities (~100% increase over 2007/08); hence, about 1 out of every 8 or 9 C. difficile cases in England were examined by CDRN.

The CDRN laboratories provide timely access to C. difficile culture and ribotyping according to standardised criteria for submission of faecal samples. In addition, further DNA fingerprinting using multilocus variable repeat analysis (MLVA) can be carried out on request, if the criteria for enhanced fingerprinting are met Guidance to access CDRNE Enhanced Fingerprinting Service (PDF, 46 KB).This is powerful tool that permits detailed analysis of clusters to determine closely related isolates, and thus may help in identifying transmission. Antimicrobial susceptibility testing surveillance (metronidazole and vancomycin) is performed by CDRN on selected isolates.

CDRN is centrally funded and thus referring laboratories/hospitals will not be charged. The service is being used to investigate clusters of cases of C. difficile infection. We aim to provide timely information to help optimise the management of C. difficile at a local level.

The CDRN service should be used by hospitals/infection control teams in England to investigate any of the following:

  • Increased frequency of cases OR high baseline rates of C. difficile infection
  • Failure to meet a trajectory / target for CDI
  • Increased severity/complications of cases of C. difficile infection
  • Increased mortality associated with C. difficile infection
  • Increased recurrence rate of C. difficile infection

Numbers of faecal samples to be submitted will be agreed via Regional Microbiologists according to the extent and severity of the above.

The CDRN service can help local teams to meet targets that have been set for reducing the incidence of C. difficile infection. Additionally, it will collect, via a mandatory request form, antibiotic risk and outcome data that can be used to provide more detailed information about C. difficile infection at a national level. Electronic requesting and reporting is being rolled out across CDRN, which increases the efficiency of the service and enhances data outputs.

The CDRN is separate from other arrangements in respect of mandatory surveillance (i.e. case-by-case web based surveillance, and fixed number of isolates per designated week).

For further information on local arrangements to access the CDRN service please contact in the first instance your Regional Microbiologist. Further details of the service can be obtained from Professor Mark Wilcox, tel: 0113 392 6818: email: Mark.Wilcox@Leedsth.nhs.uk.
 


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