Clostridium difficile-associated diarrhoea in hospitalised patients

Al-Eidan, Fahad A.; McElnay, James; Scott, Michael; Kearney, Mary P.

doi:10.1046/j.1365-2710.2000.00266.x

Cited by 74 publications

(46 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…40 This analysis led to more robust guidance on the use of antibiotics to be developed and introduced in the study site hospitals in 1995, with a significant revision in 1999 specifically to restrict the use of broad-spectrum cephalosporins in response to an outbreak of CDI, as there was strong association with the use of these agents. 41 All antibiotic usage policies were regularly reviewed and updated. Importantly, it has been emphasized that an approach combining optimal infection control practices with antimicrobial stewardship is required in order to interrupt transmission and successfully control CDI outbreaks.…”

Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Objective.To report a large outbreak ofClostridium difficileinfection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.Design.Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.Interventions.Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.Results.A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction betweenC. difficileribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months;P= .003).Conclusion.These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

show abstract

Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Antibiotics such as third generation cephalosporins are accepted as the main risk factors, and antibiotic restriction is the most effective control measure (Starr et al, 2003;Schwaber et al, 2000;McFarland et al, 1999;Al-Eidan et al, 2000). Older age, female gender and a prolonged hospital stay were identified risk factors in hospitalized CDAD patients (Al-Eidan et al, 2000). More recent studies reported the association of the use of proton pump inhibitors within the preceding 8 weeks, the use of nasal feeding tubes and exposure to antineoplastic agents with an increased risk of C. difficile diarrhoea (Cunningham et al, 2003;Komatsu et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Ackermann

Thomalla

Ackermann

et al. 2005

Journal of Medical Microbiology

View full text Add to dashboard Cite

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age .60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values , 0 . 05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

show abstract

“…4 Previous studies have found that hospitalacquired infection with C. difficile increases a patient's length of stay by one to three weeks. 2,[5][6][7][8] However, these estimates are potentially biased. First, previous studies have not accounted for the time-varying nature of this infection.…”

mentioning

confidence: 99%

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Forster

Taljaard

Oake

et al. 2011

CMAJ

View full text Add to dashboard Cite

Clostridium difficile-associated diarrhoea in hospitalised patients

Cited by 74 publications

References 40 publications

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Contact Info

Product

Resources

About