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Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106.
J Hosp Infect. 2011 Nov; 79(3):242-7.JH

Abstract

This report describes an outbreak of Clostridium difficile infection (CDI) in a vascular surgery ward in 2009 caused by a high-level clindamycin-resistant ribotype 106. A case of CDI was defined as a patient with diarrhoea, positive for C. difficile toxin and negative for other enteric pathogens. Cultures were sent to the Scottish Salmonella Shigella and Clostridium difficile Reference Laboratory (SSSCDRL) for PCR ribotyping, antibiotic susceptibility testing and PCR detection of ermB. The mean age of the nine patients was 73 years (range: 38-90 years). All had received clindamycin and ciprofloxacin. All cases were typed as PCR ribotype 106 and they showed high-level resistance to clindamycin. Five of these isolates were tested by PCR for the presence of the ermB gene and no amplification was detected. This strain has rarely been isolated from patients on this ward. The outbreak was controlled successfully by closure of the ward with terminal cleaning, reinforcement of infection control precautions and the introduction of a new antibiotic policy. It is notable that this outbreak was caused by a strain with high-level clindamycin resistance not mediated by ermB. It also re-emphasizes that outbreaks of CDI can be caused by C. difficile PCR ribotypes other than 027. The outbreak was most likely associated with the use of clindamycin and ciprofloxacin cross-infection with spores in this environment. Implementation of strict infection control precautions, antimicrobial stewardship and enhanced environmental cleaning are key components in managing such an outbreak successfully. The number of meticillin-resistant Staphylococcus aureus acquisitions also fell substantially after these interventions.

Authors+Show Affiliations

Ninewells Hospital, NHS Tayside, Dundee, UK. lratnayake@nhs.netNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21864938

Citation

Ratnayake, L, et al. "Control of an Outbreak of Diarrhoea in a Vascular Surgery Unit Caused By a High-level Clindamycin-resistant Clostridium Difficile PCR Ribotype 106." The Journal of Hospital Infection, vol. 79, no. 3, 2011, pp. 242-7.
Ratnayake L, McEwen J, Henderson N, et al. Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106. J Hosp Infect. 2011;79(3):242-7.
Ratnayake, L., McEwen, J., Henderson, N., Nathwani, D., Phillips, G., Brown, D., & Coia, J. (2011). Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106. The Journal of Hospital Infection, 79(3), 242-7. https://doi.org/10.1016/j.jhin.2011.06.013
Ratnayake L, et al. Control of an Outbreak of Diarrhoea in a Vascular Surgery Unit Caused By a High-level Clindamycin-resistant Clostridium Difficile PCR Ribotype 106. J Hosp Infect. 2011;79(3):242-7. PubMed PMID: 21864938.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106. AU - Ratnayake,L, AU - McEwen,J, AU - Henderson,N, AU - Nathwani,D, AU - Phillips,G, AU - Brown,D, AU - Coia,J, Y1 - 2011/08/23/ PY - 2010/11/25/received PY - 2011/06/11/accepted PY - 2011/8/26/entrez PY - 2011/8/26/pubmed PY - 2012/1/18/medline SP - 242 EP - 7 JF - The Journal of hospital infection JO - J Hosp Infect VL - 79 IS - 3 N2 - This report describes an outbreak of Clostridium difficile infection (CDI) in a vascular surgery ward in 2009 caused by a high-level clindamycin-resistant ribotype 106. A case of CDI was defined as a patient with diarrhoea, positive for C. difficile toxin and negative for other enteric pathogens. Cultures were sent to the Scottish Salmonella Shigella and Clostridium difficile Reference Laboratory (SSSCDRL) for PCR ribotyping, antibiotic susceptibility testing and PCR detection of ermB. The mean age of the nine patients was 73 years (range: 38-90 years). All had received clindamycin and ciprofloxacin. All cases were typed as PCR ribotype 106 and they showed high-level resistance to clindamycin. Five of these isolates were tested by PCR for the presence of the ermB gene and no amplification was detected. This strain has rarely been isolated from patients on this ward. The outbreak was controlled successfully by closure of the ward with terminal cleaning, reinforcement of infection control precautions and the introduction of a new antibiotic policy. It is notable that this outbreak was caused by a strain with high-level clindamycin resistance not mediated by ermB. It also re-emphasizes that outbreaks of CDI can be caused by C. difficile PCR ribotypes other than 027. The outbreak was most likely associated with the use of clindamycin and ciprofloxacin cross-infection with spores in this environment. Implementation of strict infection control precautions, antimicrobial stewardship and enhanced environmental cleaning are key components in managing such an outbreak successfully. The number of meticillin-resistant Staphylococcus aureus acquisitions also fell substantially after these interventions. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/21864938/Control_of_an_outbreak_of_diarrhoea_in_a_vascular_surgery_unit_caused_by_a_high_level_clindamycin_resistant_Clostridium_difficile_PCR_ribotype_106_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(11)00299-4 DB - PRIME DP - Unbound Medicine ER -