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Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors.
J Hosp Infect. 2009 Jun; 72(2):111-8.JH

Abstract

The present study investigates risk factors for onset of Clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a District General Hospital in South East England. C. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of C. difficile toxin from faecal specimens by enzyme immunoassay (Health Protection Agency, Southampton). The isolates were tested for various antimicrobial susceptibilities by E-test. Cases were assessed for prior antibiotic use and followed up for clinical outcomes. Controls were matched for age, sex, ward, length of stay and comorbidity to identify any antibiotic risk factors using conditional logistic regression analysis. Environmental sampling on wards was performed with cycloserine-cefoxitin-egg yolk agar. Forty-five percent C.difficile isolates ribotyped as 027, 39% as 106 and 10% as 001. All ribotypes were resistant to ciprofloxacin, erythromycin and cefotaxime but remained susceptible to metronidazole and vancomycin. The crude (death within 28 days) and early (death within 72h) mortalities were 23% and 11% for the 027 strain, whereas for the 106 ribotype they were 11% and 3%, respectively. The case-control study identified ciprofloxacin usage for >7 days as a significant risk factor (adjusted odds ratios of 3.72; 95% CI: 1.38-10.02; P=0.019). Environmental sampling revealed the presence of spores on faecally contaminated equipment such as commodes and bedpan shells, which persisted after cleaning. Ciprofloxacin appears to encourage C.difficile-associated diarrhoea and should be restricted to short courses. Cleaning agents for clinical equipment must have sporicidal activity to prevent cross-transmission.

Authors+Show Affiliations

Department of Microbiology, Royal Surrey County Hospital and PPS Laboratory, Frimley Park Hospital, Surrey, UK. fredasundram@btinternet.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19386381

Citation

Sundram, F, et al. "Clostridium Difficile Ribotypes 027 and 106: Clinical Outcomes and Risk Factors." The Journal of Hospital Infection, vol. 72, no. 2, 2009, pp. 111-8.
Sundram F, Guyot A, Carboo I, et al. Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors. J Hosp Infect. 2009;72(2):111-8.
Sundram, F., Guyot, A., Carboo, I., Green, S., Lilaonitkul, M., & Scourfield, A. (2009). Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors. The Journal of Hospital Infection, 72(2), 111-8. https://doi.org/10.1016/j.jhin.2009.02.020
Sundram F, et al. Clostridium Difficile Ribotypes 027 and 106: Clinical Outcomes and Risk Factors. J Hosp Infect. 2009;72(2):111-8. PubMed PMID: 19386381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors. AU - Sundram,F, AU - Guyot,A, AU - Carboo,I, AU - Green,S, AU - Lilaonitkul,M, AU - Scourfield,A, Y1 - 2009/04/21/ PY - 2008/03/30/received PY - 2009/02/20/accepted PY - 2009/4/24/entrez PY - 2009/4/24/pubmed PY - 2009/7/1/medline SP - 111 EP - 8 JF - The Journal of hospital infection JO - J Hosp Infect VL - 72 IS - 2 N2 - The present study investigates risk factors for onset of Clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a District General Hospital in South East England. C. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of C. difficile toxin from faecal specimens by enzyme immunoassay (Health Protection Agency, Southampton). The isolates were tested for various antimicrobial susceptibilities by E-test. Cases were assessed for prior antibiotic use and followed up for clinical outcomes. Controls were matched for age, sex, ward, length of stay and comorbidity to identify any antibiotic risk factors using conditional logistic regression analysis. Environmental sampling on wards was performed with cycloserine-cefoxitin-egg yolk agar. Forty-five percent C.difficile isolates ribotyped as 027, 39% as 106 and 10% as 001. All ribotypes were resistant to ciprofloxacin, erythromycin and cefotaxime but remained susceptible to metronidazole and vancomycin. The crude (death within 28 days) and early (death within 72h) mortalities were 23% and 11% for the 027 strain, whereas for the 106 ribotype they were 11% and 3%, respectively. The case-control study identified ciprofloxacin usage for >7 days as a significant risk factor (adjusted odds ratios of 3.72; 95% CI: 1.38-10.02; P=0.019). Environmental sampling revealed the presence of spores on faecally contaminated equipment such as commodes and bedpan shells, which persisted after cleaning. Ciprofloxacin appears to encourage C.difficile-associated diarrhoea and should be restricted to short courses. Cleaning agents for clinical equipment must have sporicidal activity to prevent cross-transmission. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/19386381/Clostridium_difficile_ribotypes_027_and_106:_clinical_outcomes_and_risk_factors_ DB - PRIME DP - Unbound Medicine ER -