An outbreak of Clostridium difficile infection (CDI) caused by ribotype 027 
(B1/NAP1) began in our hospital in November 2014, and produced 141 episodes in 
the following months. The aim of this study is to describe this outbreak, assess 
risk factors for recurrence of CDI-027 and to analyze the implementation of a 
novel treatment strategy. This is a prospective study of all patients with 
CDI-027, from November 2014 to November 2015. The epidemiological data were 
collected daily for each patient. We compared clinical characteristics and 
treatment between patients with and without recurrence of CDI-027. 
Interestingly, liver cirrhosis was present in 22% of the patients, and most of 
them received prophylaxis for hepatic encephalopathy with rifaximin. Patients 
were also taking antimicrobial drugs (93.6%) and proton pump inhibitors (80.1%). 
Overall, 27 (23.5%) patients had a first recurrence of CDI-027. Liver cirrhosis 
increased the risk of recurrence (44.4% vs 14.8%). Patients treated with a 
prolonged oral vancomycin regimen vs the conventional regimen (oral 
metronidazole or 10 days of vancomycin) had fewer recurrences (8.6 versus 44.7% 
[p ≤ 0.01]; OR, 0.91; 95% CI, 0.028-0.294) and less attributable mortality (0% 
versus 7.1%; p = 0.058). We report an outbreak of CDI-027, mainly in patients 
with liver cirrhosis. Recurrence of CDI-027 was more common in those patients. A 
novel approach involving high-dose prolonged vancomycin taper as a first-line 
treatment, together with a bundle of outbreak measures, seemed to reduce the 
number of cases of CDI-027, recurrences, and attributable mortality. 
Nevertheless, this approach warrants further investigation.