Management of an Outbreak ofClostridium difficile–Associated Disease Among Geriatric Patients

Infection Control and Hospital Epidemiology - Tập 27 Số 11 - Trang 1200-1205 - 2006
Soraya Cherifi1, Michel Delmée2, Johan Van Broeck2, Ingo Beyer3, B. Byl4, Georges Mascart5,6
1Departments of Internal Medicine, Brugmann University Hospital, Brussels, Belgium
2Microbiology Unit, Université catholique de Louvain, Brussels, Belgium
3Geriatrics, Brugmann University Hospital, Brussels, Belgium
4Infection Control Unit, Erasme University Hospital, Brussels, Belgium
5Infection Control Unit, Brugmann University Hospital, Brussels, Belgium
6Microbiology, Brugmann University Hospital, Brussels, Belgium

Tóm tắt

Objective.To describe a nosocomial outbreak ofClostridium difficile–associated disease (CDAD).Design.A traditional outbreak investigation.Setting.Geriatric department of a tertiary care teaching hospital from March through April 2003.Methods.The outbreak was detected by theC. difficilesurveillance program of the infection control unit. CDAD was diagnosed by stool culture and fecal toxin A detection with a qualitative rapid immunoassay. Isolates ofC difficilewere serotyped and genotyped using pulsed-field gel electrophoresis.Results.The incidence of CDAD increased from 27 cases per 100,000 patient-days in the 6-month period before the outbreak to 99 cases per 100,000 patient-days during the outbreak. This outbreak involved 21 of 92 patients in 4 geriatric wards, which were located at 2 geographically distinct sites and staffed by the same medical team. The mean age of patients was 83 years (range, 71-100 years). Five (24%) of the 21 patients had community-acquired diarrhea, and secondary hospital transmission resulted in 3 clusters involving 16 patients. Serotyping and genotyping were performed on isolates in stool specimens from 19 different patients; 16 of these isolates were serotype A1, whereas 3 displayed profiles different from the outbreak strain. Management of this outbreak consisted in reinforcement of contact isolation precautions for patients with diarrhea, cohorting of infected patients in the same ward, and promotion of hand hygiene. Relapses occurred in 6 (29%) of 21 patients.Conclusion.Control of this rapidly developing outbreak of CDAD was obtained with early implementation of cohorting and ward closure and reinforcement of environmental disinfection, hand hygiene, and enteric isolation precautions.

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Tài liệu tham khảo

Delmée, 1985, Serogrouping of Clostridium difficile strains by slide agglutination, J Clin Microbiol, 21, 323, 10.1128/JCM.21.3.323-327.1985

Delmée, 1986, Comparison of serogrouping and Polyacrylamide gel electrophoresis for typing Clostridium difficile, J Clin Microbiol, 24, 991, 10.1128/JCM.24.6.991-994.1986

10.2307/30141083

10.1093/jac/41.suppl_3.21

10.1056/NEJM198901263200402

10.1056/NEJM199911253412203

10.1016/S0140-6736(83)91036-X

10.1016/S0195-6701(97)90123-7

10.1016/0195-6701(95)90074-8

10.1016/S0002-9343(96)90008-X

10.1016/S0195-6701(99)90018-X

George, 1979, Selective and differential medium for isolation of Clostridium difficile, J Clin Microbiol, 9, 214, 10.1128/jcm.9.2.214-219.1979

Whittier, 1993, Evaluation of four commercially available enzyme immunoassays for laboratory diagnosis of Clostridium difficile–associated diseases, J Clin Microbiol, 31, 2861, 10.1128/JCM.31.11.2861-2865.1993

10.1016/S0140-6736(95)90439-5

10.1016/S0195-6701(98)90256-0

10.1016/S0195-6701(03)00115-4

10.1016/0195-6701(95)90297-X

10.1016/S0195-6701(02)00400-0

10.1093/jac/41.suppl_3.1

Thông tin
Thông tin xuất bản

Infection Control and Hospital Epidemiology

Tập 27 Số 11

1200-1205

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