An outbreak case of Clostridium difficile-associated diarrhea among elderly inpatients of an intensive care unit of a tertiary hospital m Rio de Janeiro, Brazil

The aim of this study was to investigate Clostridium difficile-associated diarrhea (CDAD) in an intensive care unit (ICU) of a tertiary hospital in Rio de Janeiro, Brazil, and to characterize epidemiologically C difficile strains obtained from an outbreak of CDAD Within almost a 4-year surveillance period, CDAD incidence was determined for the first time in Brazil, and a 3-fold increase was observed in the average rate of CDAD, featuring an outbreak About 80% of the patients were over 65 years The main antibiotic that could be probably associated to CDAD was piperacillin/tazobactam Four toxigenic strains were isolated, 3 from stools and 1 from environmental samples They were all resistant to clindamycin and fluoroquinolones Fingerprinting analysis revealed their distribution between 2 different polymerase chain reaction ribotypes, with one of them being exclusively found in Brazil It was possible to detect cross-infection and environmental contamination in the ICU Our results highlight the importance of a continuous CDAD surveillance in the hospitals, especially when a risk group is exposed (C) 2010 Elsevier Inc All rights reserved