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Emergence and control of fluoroquinolone-resistant, toxin A-negative, toxin B-positive Clostridium difficile.
Infect Control Hosp Epidemiol. 2007 Aug; 28(8):932-40.IC

Abstract

BACKGROUND

Clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. Between August 2003 and January 2004, we experienced an increase in the incidence of C. difficile-associated disease. We describe the investigation into and management of the outbreak in this article.

METHODS

A total of 73 consecutive patients with nosocomial C. difficile-associated diarrhea were identified. C. difficile isolates were characterized using toxin-specific enzyme immunoassays, a tissue-culture fibroblast cytotoxicity assay, polymerase chain reaction (PCR), and antimicrobial susceptibility tests. Rates of recurrence and of C. difficile colitis were recorded. Changes in antibiotic use and infection control policies were documented.

RESULTS

The incidence of C. difficile-associated diarrhea peaked at 21 cases per 1,000 patient admissions. Of the C. difficile isolates recovered, 85 (95%) were identical toxin A-negative and toxin B-positive strains, corresponding to toxinotype VIII and PCR ribotype 017. All clonal isolates were resistant to multiple antibiotics, including ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin (minimum inhibitory concentrations [MICs] of greater than 32 micro g/mL) and erythromycin, clarithromycin, and clindamycin (MICs of greater than 256 micro g/mL). Recurrent C. difficile-associated disease occurred in 26 (36%) of the patients. At least 10 (14%) of the patients developed C. difficile colitis. Additional infection control measures introduced included the use of ward memos, a hand-hygiene awareness campaign, increased environmental cleaning, attention to prescribing practices for antibiotics, increased awareness of diarrheal illness, and early isolation of affected patients. Total use of fluoroquinolones did not change throughout the study period. Despite persistence of this toxin-variant strain, the incidence of C. difficile-associated disease in our institution decreased to fewer than 5 cases per 1,000 admissions.

CONCLUSIONS

We report on the emergence of a fluoroquinolone- and clindamycin-resistant, toxin A-negative, and toxin B-positive strain of C. difficile associated with an outbreak of C. difficile-associated disease in our institution during a 6-month period. We found that careful attention to improvement of infection control interventions was the most important means of controlling this nosocomial pathogen.

Authors+Show Affiliations

Centre for Food Safety, School of Agriculture, University College, Dublin, Ireland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17620240

Citation

Drudy, Denise, et al. "Emergence and Control of Fluoroquinolone-resistant, Toxin A-negative, Toxin B-positive Clostridium Difficile." Infection Control and Hospital Epidemiology, vol. 28, no. 8, 2007, pp. 932-40.
Drudy D, Harnedy N, Fanning S, et al. Emergence and control of fluoroquinolone-resistant, toxin A-negative, toxin B-positive Clostridium difficile. Infect Control Hosp Epidemiol. 2007;28(8):932-40.
Drudy, D., Harnedy, N., Fanning, S., Hannan, M., & Kyne, L. (2007). Emergence and control of fluoroquinolone-resistant, toxin A-negative, toxin B-positive Clostridium difficile. Infection Control and Hospital Epidemiology, 28(8), 932-40.
Drudy D, et al. Emergence and Control of Fluoroquinolone-resistant, Toxin A-negative, Toxin B-positive Clostridium Difficile. Infect Control Hosp Epidemiol. 2007;28(8):932-40. PubMed PMID: 17620240.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence and control of fluoroquinolone-resistant, toxin A-negative, toxin B-positive Clostridium difficile. AU - Drudy,Denise, AU - Harnedy,Norma, AU - Fanning,Seamus, AU - Hannan,Margaret, AU - Kyne,Lorraine, Y1 - 2007/06/29/ PY - 2006/09/18/received PY - 2007/02/15/accepted PY - 2007/7/11/pubmed PY - 2007/8/29/medline PY - 2007/7/11/entrez SP - 932 EP - 40 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 28 IS - 8 N2 - BACKGROUND: Clostridium difficile is a major cause of infectious diarrhea in hospitalized patients. Between August 2003 and January 2004, we experienced an increase in the incidence of C. difficile-associated disease. We describe the investigation into and management of the outbreak in this article. METHODS: A total of 73 consecutive patients with nosocomial C. difficile-associated diarrhea were identified. C. difficile isolates were characterized using toxin-specific enzyme immunoassays, a tissue-culture fibroblast cytotoxicity assay, polymerase chain reaction (PCR), and antimicrobial susceptibility tests. Rates of recurrence and of C. difficile colitis were recorded. Changes in antibiotic use and infection control policies were documented. RESULTS: The incidence of C. difficile-associated diarrhea peaked at 21 cases per 1,000 patient admissions. Of the C. difficile isolates recovered, 85 (95%) were identical toxin A-negative and toxin B-positive strains, corresponding to toxinotype VIII and PCR ribotype 017. All clonal isolates were resistant to multiple antibiotics, including ofloxacin, ciprofloxacin, levofloxacin, moxifloxacin, and gatifloxacin (minimum inhibitory concentrations [MICs] of greater than 32 micro g/mL) and erythromycin, clarithromycin, and clindamycin (MICs of greater than 256 micro g/mL). Recurrent C. difficile-associated disease occurred in 26 (36%) of the patients. At least 10 (14%) of the patients developed C. difficile colitis. Additional infection control measures introduced included the use of ward memos, a hand-hygiene awareness campaign, increased environmental cleaning, attention to prescribing practices for antibiotics, increased awareness of diarrheal illness, and early isolation of affected patients. Total use of fluoroquinolones did not change throughout the study period. Despite persistence of this toxin-variant strain, the incidence of C. difficile-associated disease in our institution decreased to fewer than 5 cases per 1,000 admissions. CONCLUSIONS: We report on the emergence of a fluoroquinolone- and clindamycin-resistant, toxin A-negative, and toxin B-positive strain of C. difficile associated with an outbreak of C. difficile-associated disease in our institution during a 6-month period. We found that careful attention to improvement of infection control interventions was the most important means of controlling this nosocomial pathogen. SN - 0899-823X UR - https://www.unboundmedicine.com/medline/citation/17620240/Emergence_and_control_of_fluoroquinolone_resistant_toxin_A_negative_toxin_B_positive_Clostridium_difficile_ L2 - https://www.cambridge.org/core/product/identifier/ICHE2006311/type/journal_article DB - PRIME DP - Unbound Medicine ER -