TY - JOUR
T1 - Successful combat of an outbreak due to Clostridium difficile PCR ribotype 027 and recognition of specific risk factors
AU - Debast, S. B.
AU - Vaessen, N.
AU - Choudry, A.
AU - Wiegers-Ligtvoet, E. A.J.
AU - van den Berg, R. J.
AU - Kuijper, E. J.
N1 - Funding Information: This study was not sponsored commercially. St Jansdal Hospital provided a grant for a 6-month fellowship to A. Choudry. The authors did not have any dual or conflicting interests.
PY - 2009
Y1 - 2009
N2 - Clin Microbiol Infect 2009; 00: 000-000: In the period April-September 2005, an outbreak of Clostridium difficile infection (CDI) due to PCR ribotype .027 occurred among 50 patients in a 341-bed community hospital in Harderwijk, The Netherlands. A retrospective case-control study was performed to identify risk factors specific for CDI, using a group of patients with CDI (n = 45), a group of randomly selected control patients without diarrhoea (n = 90), and a group of patients with non-infectious diarrhoea (n = 109). Risk factors for CDI and for non-CDI diarrhoea were identified using multiple logistic regression analysis. Independent risk factors for CDI were: age above 65 years (OR 2.6; 95% CI 1.0-5.7), duration of hospitalization (OR 1.04 per additional day; 95% CI 1.0-1.1), and antibiotic use (OR 12.5; 95% CI 3.2-48.1). Of the antibiotics used, cephalosporins and fluoroquinolones were identified as the major risk factors for development of CDI. The risk of developing CDI was particularly high in people receiving a combination of a cephalosporin and a fluoroquinolone (OR 57.5; 95% CI 6.8-483.6). The main factors affecting the risk of non-CDI diarrhoea were proton-pump inhibitors, immunosuppressive drugs, underlying digestive system disease, previous surgery, and gastric tube feeding. The outbreak ended only after implementation of restricted use of cephalosporins and a complete ban on fluoroquinolones, in addition to general hygienic measures, cohorting of patients in a separate ward, education of staff, and intensified environmental cleaning. The results of this study support the importance of appropriate antimicrobial stewardship in the control of hospital outbreaks with C. difficile PCR ribotype 027.
AB - Clin Microbiol Infect 2009; 00: 000-000: In the period April-September 2005, an outbreak of Clostridium difficile infection (CDI) due to PCR ribotype .027 occurred among 50 patients in a 341-bed community hospital in Harderwijk, The Netherlands. A retrospective case-control study was performed to identify risk factors specific for CDI, using a group of patients with CDI (n = 45), a group of randomly selected control patients without diarrhoea (n = 90), and a group of patients with non-infectious diarrhoea (n = 109). Risk factors for CDI and for non-CDI diarrhoea were identified using multiple logistic regression analysis. Independent risk factors for CDI were: age above 65 years (OR 2.6; 95% CI 1.0-5.7), duration of hospitalization (OR 1.04 per additional day; 95% CI 1.0-1.1), and antibiotic use (OR 12.5; 95% CI 3.2-48.1). Of the antibiotics used, cephalosporins and fluoroquinolones were identified as the major risk factors for development of CDI. The risk of developing CDI was particularly high in people receiving a combination of a cephalosporin and a fluoroquinolone (OR 57.5; 95% CI 6.8-483.6). The main factors affecting the risk of non-CDI diarrhoea were proton-pump inhibitors, immunosuppressive drugs, underlying digestive system disease, previous surgery, and gastric tube feeding. The outbreak ended only after implementation of restricted use of cephalosporins and a complete ban on fluoroquinolones, in addition to general hygienic measures, cohorting of patients in a separate ward, education of staff, and intensified environmental cleaning. The results of this study support the importance of appropriate antimicrobial stewardship in the control of hospital outbreaks with C. difficile PCR ribotype 027.
KW - Antibiotic treatment
KW - Antimicrobial stewardship
KW - Cephalosporin
KW - Clostridium difficile infection
KW - Diarrhoea
KW - Outbreak control
KW - Quinolone
UR - http://www.scopus.com/inward/record.url?scp=65949097951&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/j.1469-0691.2009.02713.x
DO - https://doi.org/10.1111/j.1469-0691.2009.02713.x
M3 - Article
C2 - 19416295
SN - 1198-743X
VL - 15
SP - 427
EP - 434
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 5
ER -