A large outbreak of Clostridium difficile‐associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased Fluoroquinolone use

Muto, Carlene A., Pokrywka, Marian, Shutt, Kathleen, Mendelsohn, Aaron B., Nouri, Kathy, Posey, Kathy, Roberts, Terri, Croyle, Karen, Krystofiak, Sharon, Patel‐Brown, Sujata, Pasculle, William, Paterson, David L., Saul, Melissa and Harrison, Lee H. (2005) A large outbreak of Clostridium difficile‐associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased Fluoroquinolone use. Infection Control and Hospital Epidemiology, 26 3: 273-280. doi:10.1086/502539

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Author Muto, Carlene A.
Pokrywka, Marian
Shutt, Kathleen
Mendelsohn, Aaron B.
Nouri, Kathy
Posey, Kathy
Roberts, Terri
Croyle, Karen
Krystofiak, Sharon
Patel‐Brown, Sujata
Pasculle, William
Paterson, David L.
Saul, Melissa
Harrison, Lee H.
Title A large outbreak of Clostridium difficile‐associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased Fluoroquinolone use
Formatted title
A large outbreak of Clostridium difficile‐associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased Fluoroquinolone use
Journal name Infection Control and Hospital Epidemiology   Check publisher's open access policy
ISSN 0899-823X
1559-6834
Publication date 2005-03
Year available 2005
Sub-type Article (original research)
DOI 10.1086/502539
Open Access Status File (Publisher version)
Volume 26
Issue 3
Start page 273
End page 280
Total pages 8
Place of publication New York, NY, United States
Publisher Cambridge University Press
Language eng
Formatted abstract
Background and Objective: Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1,000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and characterize the outbreak

Methods
: A retrospective case–control study of casepatients with C. difficile infection from January 2000 through April 2001 and control‐patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed.

Results:On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI95], 1.9–12.0), ceftriaxone (OR, 5.4; CI95, 1.8–15.8), and levofloxacin (OR, 2.0; CI95, 1.2–3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P < .001); 59% of case‐patients and 41% of control‐patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes.

Conclusions:
Exposure to levofloxacin was an independent risk factor for C. difficile–associated diarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak.

© The Society for Healthcare Epidemiology of America 2005
Keyword Fluoroquinolones
Clostridium difficile
Hospitals
Antibiotics
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
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Created: Fri, 22 Jan 2010, 15:15:20 EST by Macushla Boyle on behalf of Royal Brisbane Clinical School