Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures

M.A. Aldeyab, M.J. Devine, P. Flanagan, M. Mannion, A. Craig, M.G. Scott, S. Harbarth, N. Vernaz, E Davies, J.S. Brazier, B. Smyth, J.C. McElnay, B.F. Gilmore, G. Conlon, F.A. Magee, F.W.D. Elhajji, S. Small, C. Edwards, C. Funston, M.P. Kearney

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. DESIGN. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. INTERVENTIONS. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. RESULTS. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P=.003). CONCLUSION. These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance. © 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.
LanguageEnglish
Pages210-219
Number of pages10
JournalInfection Control and Hospital Epidemiology
Volume32
Issue number3
Publication statusPublished - Mar 2011

Fingerprint

Ribotyping
Clostridium difficile
Disease Outbreaks
Epidemiology
Infection Control
Fluoroquinolones
Infection
Anti-Bacterial Agents
Hygiene
Clostridium Infections
Northern Ireland
Environmental Monitoring
Causality
Cause of Death
Communication
Guidelines
Delivery of Health Care
Mortality
Incidence

Keywords

  • amoxicillin plus clavulanic acid
  • macrolide
  • quinolone derivative
  • aged
  • article
  • cause of death
  • Clostridium difficile infection
  • environmental sanitation
  • epidemic
  • female
  • human
  • infection control
  • major clinical study
  • male
  • United Kingdom
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents
  • Clostridium difficile
  • Clostridium Infections
  • Cross Infection
  • Disease Outbreaks
  • Drug Utilization
  • Female
  • Fluoroquinolones
  • Hospitals
  • Humans
  • Incidence
  • Infection Control
  • Male
  • Northern Ireland
  • Ribotyping
  • Risk Factors

Cite this

Aldeyab, M. A., Devine, M. J., Flanagan, P., Mannion, M., Craig, A., Scott, M. G., ... Kearney, M. P. (2011). Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures. Infection Control and Hospital Epidemiology, 32(3), 210-219.
Aldeyab, M.A. ; Devine, M.J. ; Flanagan, P. ; Mannion, M. ; Craig, A. ; Scott, M.G. ; Harbarth, S. ; Vernaz, N. ; Davies, E ; Brazier, J.S. ; Smyth, B. ; McElnay, J.C. ; Gilmore, B.F. ; Conlon, G. ; Magee, F.A. ; Elhajji, F.W.D. ; Small, S. ; Edwards, C. ; Funston, C. ; Kearney, M.P. / Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures. In: Infection Control and Hospital Epidemiology. 2011 ; Vol. 32, No. 3. pp. 210-219.
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title = "Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures",
abstract = "OBJECTIVE. To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. DESIGN. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. INTERVENTIONS. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. RESULTS. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5{\%}; however, CDI was the attributable cause of death for only 2.5{\%} of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P=.003). CONCLUSION. These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance. {\circledC} 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.",
keywords = "amoxicillin plus clavulanic acid, macrolide, quinolone derivative, aged, article, cause of death, Clostridium difficile infection, environmental sanitation, epidemic, female, human, infection control, major clinical study, male, United Kingdom, Aged, Aged, 80 and over, Anti-Bacterial Agents, Clostridium difficile, Clostridium Infections, Cross Infection, Disease Outbreaks, Drug Utilization, Female, Fluoroquinolones, Hospitals, Humans, Incidence, Infection Control, Male, Northern Ireland, Ribotyping, Risk Factors",
author = "M.A. Aldeyab and M.J. Devine and P. Flanagan and M. Mannion and A. Craig and M.G. Scott and S. Harbarth and N. Vernaz and E Davies and J.S. Brazier and B. Smyth and J.C. McElnay and B.F. Gilmore and G. Conlon and F.A. Magee and F.W.D. Elhajji and S. Small and C. Edwards and C. Funston and M.P. Kearney",
note = "Cited By :37 Export Date: 15 September 2018 CODEN: ICEPE Correspondence Address: Aldeyab, M. A.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: maldeyab02@qub.ac.uk Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; Anti-Bacterial Agents; Fluoroquinolones References: Thompson, I., Clostridium difficile - Associated disease: Update and focus on non - Antibiotic strategies (2008) Age and Ageing, 37 (1), pp. 14-18. , DOI 10.1093/ageing/afm159; Kuijper, E.J., Barbut, F., Brazier, J.S., Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008 (2008) Eurosurveillance, 13 (31). , pii: 18942; McFarland, L.V., Update on the changing epidemiology of Clostridium difficile-associated disease (2008) Nat Clin Pract Gastroenterol Hepatol, 5, pp. 40-48; Labb{\'e}, A.-C., Poirier, L., MacCannell, D., Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain (2008) Antimicrob Agents Chemother, 52, pp. 3180-3187; Warny, M., Pepin, J., Fang, A., Killgore, G., Thompson, A., Brazier, J., Frost, E., McDonald, L.C., Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe (2005) Lancet, 366 (9491), pp. 1079-1084. , DOI 10.1016/S0140-6736(05)67420-X, PII S014067360567420X; Debast, S.B., Vaessen, N., Choudry, A., Wiegers-Ligtvoet, E.A., Van Den Berg, R.J., Kuijper, E.J., Successful combat of an outbreak due to Clostridium difficile PCR ribotype 027 and recognition of specific risk factors (2009) Clin Microbiol Infect, 15, pp. 427-434; MacCannell, D.R., Louie, T.J., Gregson, D.B., Laverdiere, M., Labbe, A.-C., Laing, F., Henwick, S., Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada (2006) Journal of Clinical Microbiology, 44 (6), pp. 2147-2152. , DOI 10.1128/JCM.02563-05; Long, S., Fenelon, L., Fitzgerald, S., First isolation and report of clusters of Clostridium difficile PCR 027 cases in Ireland (2007) Eurosurveillance, 12 (17). , pii=3183; Aldeyab, M.A., Monnet, D.L., L{\'o}pez-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Shardell, M., Harris, A.D., El-Kamary, S.S., Furuno, J.P., Miller, R.R., Perencevich, E.N., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clinical Infectious Diseases, 45 (7), pp. 901-907. , DOI 10.1086/521255; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; O'Neill, G.L., Ogunsola, F.T., Brazier, J.S., Duerden, B.I., Modification of a PCR ribotyping method for application as a routine typing scheme for Clostridium difficile (1996) Anaerobe, 2 (4), pp. 205-209. , DOI 10.1006/anae.1996.0028; Stubbs, S.L.J., Brazier, J.S., O'Neill, G.L., Duerden, B.I., PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes (1999) Journal of Clinical Microbiology, 37 (2), pp. 461-463; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scandinavian Journal of Gastroenterology, 32 (9), pp. 920-924; McDonald, L.C., Coignard, B., Dubberke, E., Song, X., Horan, T., Kutty, P.K., Chinn, R., Perl, T.M., Recommendations for surveillance of Clostridium difficile-associated disease (2007) Infection Control and Hospital Epidemiology, 28 (2), pp. 140-145. , DOI 10.1086/511798; (2002) Guidelines for ATC Classifications and DDD Assignment, , WHO Collaborating Center for Drug Statistics Methodology. 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year = "2011",
month = "3",
language = "English",
volume = "32",
pages = "210--219",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "Cambridge University Press",
number = "3",

}

Aldeyab, MA, Devine, MJ, Flanagan, P, Mannion, M, Craig, A, Scott, MG, Harbarth, S, Vernaz, N, Davies, E, Brazier, JS, Smyth, B, McElnay, JC, Gilmore, BF, Conlon, G, Magee, FA, Elhajji, FWD, Small, S, Edwards, C, Funston, C & Kearney, MP 2011, 'Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures', Infection Control and Hospital Epidemiology, vol. 32, no. 3, pp. 210-219.

Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures. / Aldeyab, M.A.; Devine, M.J.; Flanagan, P.; Mannion, M.; Craig, A.; Scott, M.G.; Harbarth, S.; Vernaz, N.; Davies, E; Brazier, J.S.; Smyth, B.; McElnay, J.C.; Gilmore, B.F.; Conlon, G.; Magee, F.A.; Elhajji, F.W.D.; Small, S.; Edwards, C.; Funston, C.; Kearney, M.P.

In: Infection Control and Hospital Epidemiology, Vol. 32, No. 3, 03.2011, p. 210-219.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multihospital outbreak of Clostridium difficile ribotype 027 infection: Epidemiology and analysis of control measures

AU - Aldeyab, M.A.

AU - Devine, M.J.

AU - Flanagan, P.

AU - Mannion, M.

AU - Craig, A.

AU - Scott, M.G.

AU - Harbarth, S.

AU - Vernaz, N.

AU - Davies, E

AU - Brazier, J.S.

AU - Smyth, B.

AU - McElnay, J.C.

AU - Gilmore, B.F.

AU - Conlon, G.

AU - Magee, F.A.

AU - Elhajji, F.W.D.

AU - Small, S.

AU - Edwards, C.

AU - Funston, C.

AU - Kearney, M.P.

N1 - Cited By :37 Export Date: 15 September 2018 CODEN: ICEPE Correspondence Address: Aldeyab, M. A.; Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom; email: maldeyab02@qub.ac.uk Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; Anti-Bacterial Agents; Fluoroquinolones References: Thompson, I., Clostridium difficile - Associated disease: Update and focus on non - Antibiotic strategies (2008) Age and Ageing, 37 (1), pp. 14-18. , DOI 10.1093/ageing/afm159; Kuijper, E.J., Barbut, F., Brazier, J.S., Update of Clostridium difficile infection due to PCR ribotype 027 in Europe, 2008 (2008) Eurosurveillance, 13 (31). , pii: 18942; McFarland, L.V., Update on the changing epidemiology of Clostridium difficile-associated disease (2008) Nat Clin Pract Gastroenterol Hepatol, 5, pp. 40-48; Labbé, A.-C., Poirier, L., MacCannell, D., Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP1/027 strain (2008) Antimicrob Agents Chemother, 52, pp. 3180-3187; Warny, M., Pepin, J., Fang, A., Killgore, G., Thompson, A., Brazier, J., Frost, E., McDonald, L.C., Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe (2005) Lancet, 366 (9491), pp. 1079-1084. , DOI 10.1016/S0140-6736(05)67420-X, PII S014067360567420X; Debast, S.B., Vaessen, N., Choudry, A., Wiegers-Ligtvoet, E.A., Van Den Berg, R.J., Kuijper, E.J., Successful combat of an outbreak due to Clostridium difficile PCR ribotype 027 and recognition of specific risk factors (2009) Clin Microbiol Infect, 15, pp. 427-434; MacCannell, D.R., Louie, T.J., Gregson, D.B., Laverdiere, M., Labbe, A.-C., Laing, F., Henwick, S., Molecular analysis of Clostridium difficile PCR ribotype 027 isolates from Eastern and Western Canada (2006) Journal of Clinical Microbiology, 44 (6), pp. 2147-2152. , DOI 10.1128/JCM.02563-05; Long, S., Fenelon, L., Fitzgerald, S., First isolation and report of clusters of Clostridium difficile PCR 027 cases in Ireland (2007) Eurosurveillance, 12 (17). , pii=3183; Aldeyab, M.A., Monnet, D.L., López-Lozano, J.M., Modelling the impact of antibiotic use and infection control practices on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus: A time-series analysis (2008) J Antimicrob Chemother, 62, pp. 593-600; Shardell, M., Harris, A.D., El-Kamary, S.S., Furuno, J.P., Miller, R.R., Perencevich, E.N., Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies (2007) Clinical Infectious Diseases, 45 (7), pp. 901-907. , DOI 10.1086/521255; Aldeyab, M.A., Harbarth, S., Vernaz, N., Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients (2009) Antimicrob Agents Chemother, 53, pp. 2082-2088; O'Neill, G.L., Ogunsola, F.T., Brazier, J.S., Duerden, B.I., Modification of a PCR ribotyping method for application as a routine typing scheme for Clostridium difficile (1996) Anaerobe, 2 (4), pp. 205-209. , DOI 10.1006/anae.1996.0028; Stubbs, S.L.J., Brazier, J.S., O'Neill, G.L., Duerden, B.I., PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes (1999) Journal of Clinical Microbiology, 37 (2), pp. 461-463; Lewis, S.J., Heaton, K.W., Stool form scale as a useful guide to intestinal transit time (1997) Scandinavian Journal of Gastroenterology, 32 (9), pp. 920-924; McDonald, L.C., Coignard, B., Dubberke, E., Song, X., Horan, T., Kutty, P.K., Chinn, R., Perl, T.M., Recommendations for surveillance of Clostridium difficile-associated disease (2007) Infection Control and Hospital Epidemiology, 28 (2), pp. 140-145. , DOI 10.1086/511798; (2002) Guidelines for ATC Classifications and DDD Assignment, , WHO Collaborating Center for Drug Statistics Methodology. Oslo: WHO Collaborating Center; (2007) High Impact Intervention No 7: Care Bundle to Reduce the Risk from Clostridium difficile, , http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/ documents/digitalasset/dh_078126.pdf, Accessed January 30, 2010; Guidance on Death, Stillbirth and Cremation Certification, , http://www.dhsspsni.gov.uk/show_publications?txtidp32940, Accessed January 30, 2010; Helfenstein, U., Box-Jenkins modelling in medical research (1996) Stat Methods Med Res, 5, pp. 3-22; Tobacman, J.K., Assessment of comorbidity: A review (1994) Clin Perform Qual Health Care, 2, pp. 23-32; Stone, S.P., Cooper, B.S., Kibbler, C.C., Cookson, B.D., Roberts, J.A., Medley, G.F., Duckworth, G., Davey, P.G., The ORION statement: Guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection (2007) Lancet Infectious Diseases, 7 (4), pp. 282-288. , DOI 10.1016/S1473-3099(07)70082-8, PII S1473309907700828; Schwaber, M.J., Simhon, A., Block, C., Roval, V., Ferderber, N., Shapiro, M., Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital (2000) European Journal of Clinical Microbiology and Infectious Diseases, 19 (1), pp. 9-15; Muto, C.A., Pokrywka, M., Shutt, K., Mendelsohn, A.B., Nouri, K., Posey, K., Roberts, T., Harrison, L.H., A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use (2005) Infection Control and Hospital Epidemiology, 26 (3), pp. 273-280. , DOI 10.1086/502539; Baxter, R., Ray, G.T., Fireman, B.H., Case-control study of antibiotic use and subsequent Clostridium difficile-associated diarrhea in hospitalized patients (2008) Infection Control and Hospital Epidemiology, 29 (1), pp. 44-50. , DOI 10.1086/524320; Owens Jr., R.C., Donskey, C.J., Gaynes, R.P., Loo, V.G., Muto, C.A., Antimicrobial-associated risk factors for Clostridium difficile infection (2008) Clinical Infectious Diseases, 46 (SUPPL. 1), pp. S19-S31. , DOI 10.1086/521859; Akhtar, A.J., Shaheen, M., Increasing incidence of Clostridium difficile-associated diarrhea in African-American and Hispanic patients: Association with the use of proton pump inhibitor therapy (2007) Journal of the National Medical Association, 99 (5), pp. 500-504; Cadle, R.M., Mansouri, M.D., Logan, N., Kudva, D.R., Musher, D.M., Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis (2007) American Journal of Health-System Pharmacy, 64 (22), pp. 2359-2363. , DOI 10.2146/ajhp060629; Dial, S., Delaney, J.A.C., Barkun, A.N., Suissa, S., Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease (2005) Journal of the American Medical Association, 294 (23), pp. 2989-2995. , http://jama.ama-assn.org/cgi/reprint/294/23/2989, DOI 10.1001/jama.294.23.2989; Apisarnthanarak, A., Zack, J.E., Mayfield, J.L., Freeman, J., Dunne, W.M., Little, J.R., Mundy, L.M., Fraser, V.J., Effectiveness of environmental and infection control programs to reduce transmission of Clostridium difficile [3] (2004) Clinical Infectious Diseases, 39 (4), pp. 601-602. , DOI 10.1086/422523; Clostridium difficile - RQIA Independent Review. Review of the Outbreak of Clostridium difficile in the Northern Health and Social Care Trust, , http://www.dhsspsni.gov.uk/assemblydocumentcdiff14108.pdf, Regulation and Quality Improvement Authority (United Kingdom). Accessed July 1, 2010; Aldeyab, M.A., Elshibly, S.M., McElnay, J.C., An evaluation of compliance with an antibiotic policy in surgical wards at a general teaching hospital in Northern Ireland (2009) Infect Control Hosp Epidemiol, 30, pp. 921-922; Kuijper, E.J., Coignard, B., Tüll, P., Emergence of Clostridium difficile-associated disease in North America and Europe (2006) Clin Microbiol Infect, 12 (SUPPL. 6), pp. 2-18. , ESCMID Study Group for Clostridium difficile, EU Member States, European Centre for Disease Prevention and Control; Morgan, O.W., Rodrigues, B., Elston, T., Clinical severity of Clostridium difficile PCR ribotype 027: A case-case study (2008) PLoS One, 3 (3), pp. e1812; Loo, V.G., Poirier, L., Miller, M.A., Oughton, M., Libman, M.D., Michaud, S., Bourgault, A.-M., Dascal, A., A predominantly clonal multi-institutional outbreak of Clostridium difficile - Associated diarrhea with high morbidity and mortality (2005) New England Journal of Medicine, 353 (23), pp. 2442-2449. , http://content.nejm.org/cgi/reprint/353/23/2442.pdf, DOI 10.1056/NEJMoa051639; Hubert, B., Loo, V.G., Bourgault, A.-M., Poirier, L., Dascal, A., Fortin, E., Dionne, M., Lorange, M., A portrait of the geographic dissemination of the Clostridium difficile North American pulsed-field type 1 strain and the epidemiology of C. difficile-associated disease in Québec (2007) Clinical Infectious Diseases, 44 (2), pp. 238-244. , DOI 10.1086/510391; Barbut, F., Gariazzo, B., Bonné, L., Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: Results of a retrospective study, 2000-2004 (2007) Infect Control Hosp Epidemiol, 28, pp. 131-139; Goorhuis, A., Van, D.K.T., Vaessen, N., Dekker, F.W., Van, D.B.R., Harmanus, C., Van, D.H.S., Kuijper, E.J., Spread and epidemiology of Clostridium difficile polymerase chain reaction ribotype 027/toxinotype III in the Netherlands (2007) Clinical Infectious Diseases, 45 (6), pp. 695-703. , DOI 10.1086/520984; Miller, M., Gravel, D., Mulvey, M., Health care-associated Clostridium difficil infection in Canada: Patient age and infecting strain type are highly predictive of severe outcome andmortality (2010) Clin Infect Dis, 50, pp. 194-201; Kallen, A.J., Thompson, A., Ristaino, P., Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital (2009) Infect Control Hosp Epidemiol, 30, pp. 264-272; McElnay, J.C., Scott, M.G., Sidara, J.Y., Kearney, P., Audit of antibiotic usage in medium-sized general hospital over an 11-year period: The impact of antibiotic policies (1995) Pharm World Sci, 17, pp. 207-213; Al-Eidan, F.A., McElnay, J.C., Scott, M.G., Kearney, M.P., Clostridium difficile-associated diarrhoea in hospitalised patients (2000) Journal of Clinical Pharmacy and Therapeutics, 25 (2), pp. 101-109. , DOI 10.1046/j.1365-2710.2000.00266.x; Valiquette, L., Cossette, B., Garant, M.-P., Diab, H., Pepin, J., Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain (2007) Clinical Infectious Diseases, 45 (SUPPL. 2), pp. S112-S121. , DOI 10.1086/519258; Vonberg, R.-P., Kuijper, E.J., Wilcox, M.H., Barbut, F., Tull, P., Gastmeier, P., Van, D.B.P.J., Wiuff, C., Infection control measures to limit the spread of Clostridium difficile (2008) Clinical Microbiology and Infection, 14 (SUPPL. 5), pp. 2-20. , DOI 10.1111/j.1469-0691.2008.01992.x, Infection control measures to limit spread of Clostridium

PY - 2011/3

Y1 - 2011/3

N2 - OBJECTIVE. To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. DESIGN. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. INTERVENTIONS. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. RESULTS. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P=.003). CONCLUSION. These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance. © 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.

AB - OBJECTIVE. To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak. DESIGN. Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland. INTERVENTIONS. Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene. RESULTS. A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, -0.054; lag time, 4 months; P=.003). CONCLUSION. These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance. © 2011 by The Society for Healthcare Epidemiology of America. All rights reserved.

KW - amoxicillin plus clavulanic acid

KW - macrolide

KW - quinolone derivative

KW - aged

KW - article

KW - cause of death

KW - Clostridium difficile infection

KW - environmental sanitation

KW - epidemic

KW - female

KW - human

KW - infection control

KW - major clinical study

KW - male

KW - United Kingdom

KW - Aged

KW - Aged, 80 and over

KW - Anti-Bacterial Agents

KW - Clostridium difficile

KW - Clostridium Infections

KW - Cross Infection

KW - Disease Outbreaks

KW - Drug Utilization

KW - Female

KW - Fluoroquinolones

KW - Hospitals

KW - Humans

KW - Incidence

KW - Infection Control

KW - Male

KW - Northern Ireland

KW - Ribotyping

KW - Risk Factors

M3 - Article

VL - 32

SP - 210

EP - 219

JO - Infection Control and Hospital Epidemiology

T2 - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

IS - 3

ER -