Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital

Abstract

SUMMARYThe objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin.In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (≥ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR.From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fiftytwo percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles.In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.

Clostridium difficile: a problem of concern in developed countries and still a mystery in Latin America

“…The spread of C. difficile internationally was therefore demonstrated and was identified as a potential contributor to the occurrence of worldwide outbreaks, as was seen with strain 027/BI/NAP-1. Dias et al (2010) published an interesting study, in which they reported a suspected outbreak of CDAD in a private hospital. It was observed that in February 2002, three cases of CDAD were detected, and in March of the same year, seven cases occurred.…”

Detection and pathogenic potential of Clostridium difficile in commercial meat and meat products in Brazil

“…However, a systematic review of the epidemiology of human infection in Brazil has been published (Trindade et al, 2019). The review found that infections acquired from hospital environments (Balassiano et al, 2009;Dias et al, 2010;Secco et al, 2014) are more common than community acquired cases (Costa et al, 2014;Pires et al, 2014). Antimicrobial resistance of human and animal isolates has been reported in Brazil (Balassiano et al, 2009(Balassiano et al, , 2011Secco et al, 2014, Silva et al, 2014, however, research on isolates from food has not yet been appointed.…”