PSEUDO-OUTBREAK OF Clostridium difficile ASSOCIATED DIARRHEA (CDAD) IN A TERTIARY-CARE HOSPITAL

被引:10
作者
Beatriz Souza Dias, M. [1 ,2 ]
Yamashiro, Juliana [1 ]
Borrasca, Vera L. [2 ]
Stempliuk, Valeska A. [3 ]
Araujo, Maria Rita E. [4 ]
Costa, Silvia F. [5 ,6 ]
Levin, Anna S. [1 ,5 ,6 ]
机构
[1] Univ Sao Paulo, Hosp Clin, Dept Infect Control, Sao Paulo, Brazil
[2] Hosp Sirio Libanes, Infect Control Unit, Sao Paulo, Brazil
[3] Inst Sirio Libanes Ensiono & Pesquisa, Sao Paulo, Brazil
[4] Hosp Beneficencia Portuguesa, Microbiol Lab, Sao Paulo, Brazil
[5] Univ Sao Paulo, Dept Infect Dis, Sao Paulo, Brazil
[6] Univ Sao Paulo, LIM 54, Sao Paulo, Brazil
来源
REVISTA DO INSTITUTO DE MEDICINA TROPICAL DE SAO PAULO | 2010年 / 52卷 / 03期
关键词
Clostridium difficile; Pseudo-outbreak; Molecular typing; Community-acquired; RESTRICTION-ENDONUCLEASE ANALYSIS; POLYMERASE-CHAIN-REACTION; TYPING METHODS; TOXIN-B; INFECTION; STRAINS; EMERGENCE; RISK;
D O I
10.1590/S0036-46652010000300004
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.
引用
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页码:133 / 137
页数:5
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