A Large Outbreak of Clostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use
By C. Muto, M. Pokrywka, K. Shutt, A. Mendelsohn, K. Nouri, Kathy Posey, Terri L. Roberts, Karen Croyle, Sharon Krystoflak, S. Patel-Brown and 4 more. Infection Control & Hospital Epidemiology, 2005
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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 case-patients 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.
Subfields: Applied Microbiology and Biotechnology, Critical Care and Intensive Care Medicine, Infectious Diseases
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Citations in the corpus
- Antimicrobial-associated risk factors for Clostridium difficile infection. (2008, background): “strain has been isolated with varying frequency in at least 8 North American outbreaks since 2001, and isolates from these outbreaks have been fully resistant to all of the fluoroquinolones tested [12, 18].”
- Clostridium difficile--associated disease in a setting of endemicity: identification of novel risk factors. (2007, result): “Previous studies have suggested that increased prescribing of newer fluoroquinolones has contributed to CDAD outbreaks [3, 4, 6].”
- Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). (2018, neutral): “Virtually every antibiotic has been associated with CDI through the years, but certain classes—third-/fourth-generation cephalosporins [99], fluoroquinolones [36, 37, 100], carbapenems [99], and clindamycin [101, 102]—have been found to be high risk.”
- Clostridium difficile infection: new developments in epidemiology and pathogenesis (2009, background): “difficile BI/NAP1/027 has been documented in hospitals in 40 states in the United States, in all the provinces of Canada and in most European countrie”
- Role of hand hygiene in healthcare-associated infection prevention. (2009, background): “difficileassociated disease.(66) In addition, several studies recently demonstrated a lack of association between the consumption of alcohol-based hand rubs and the incidence of clinical isolates of C.”
- Narrative Review: The New Epidemic of Clostridium difficileAssociated Enteric Disease (2006, background): “The newly implicated class of antibiotics was fluoroquinolones for most of the recent outbreaks, although cephalosporins still accounted for a substantial portion (20, 63, 68, 71).”
- Development and Validation of a Clostridium difficile Infection Risk Prediction Model (2011, background): “Despite the breadth and depth of knowledge about risk factors available in the medical literature, healthcare facilities still struggle with outbreaks of CDI and increasing rates of disease.(4-7,9,18-20) Most CDI prevention and control strategies, such as the use of contact precautions and environme”
- Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. (2005, neutral): “needed a colectomy [33].”
- The Changing Epidemiology of Clostridium difficile Infections (2010, background): “C lidam cin nd ineased duation of gatoxacin thrapy M to et al(139) 20–2001 Pittrgh,PA”
- Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec (2005, background): “A lingering question that remains unanswered is why this strain of C. difficile spread so extensively within and between hospitals in Quebec, while dissemination of the same hypervirulent, and presumably highly infectious, strain seems to have been more limited in the rest of Canada and the United S”