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Nosocomial outbreak of Clostridium difficile diarrhea in a pediatric service
Insights
An outbreak of nosocomial diarrhea in a pediatric orthopedic service was linked to lincomycin use. Discontinuing this antibiotic and improving hygiene measures successfully ended the Clostridium difficile outbreak.
Area of Science:
- Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Nosocomial diarrhea outbreaks pose significant risks in healthcare settings, particularly in pediatric populations.
- Clostridium difficile infection (CDI) is a common cause of antibiotic-associated diarrhea.
- Pediatric orthopedic services may have unique vulnerabilities to infectious outbreaks.
Purpose of the Study:
- To investigate the cause and control of a nosocomial diarrhea outbreak in a pediatric orthopedic service.
- To identify risk factors associated with Clostridium difficile infection during the outbreak.
- To characterize the Clostridium difficile isolates involved in the outbreak.
Main Methods:
- Retrospective case-control study analyzing patient data.
- Multivariate analysis to identify risk factors.
- Bacteriological and molecular characterization of Clostridium difficile isolates, including cytotoxin detection and pulsed-field gel electrophoresis (PFGE).
Main Results:
- 37 patients were involved in the outbreak, with six confirmed Clostridium difficile infections.
- Lincomycin treatment for at least three days was identified as the sole significant risk factor.
- All Clostridium difficile isolates belonged to serogroup C, were lincomycin-resistant, and showed identical PFGE patterns.
- Asymptomatic patients also shed Clostridium difficile and its cytotoxins.
Conclusions:
- Lincomycin treatment was the primary driver of this Clostridium difficile outbreak in a pediatric orthopedic unit.
- Strict adherence to infection control measures and judicious antibiotic use are crucial for preventing and controlling nosocomial CDI.
- The genetic homogeneity of the isolates suggests a common source or efficient transmission within the unit.
Abstract:
An outbreak of nosocomial diarrhea that occurred in a pediatric orthopedic service between 1 December 1993 and 15 April 1994 is reported. A total of 37 patients (mean age, 9.6 years; range, 2 months-19.3 years) were involved in the outbreak, including six patients with bacteriologically documented Clostridium difficile infection. A multivariate analysis identified lincomycin treatment for at least three days as the only significant risk factor. Stool samples from four asymptomatic patients were also positive for Clostridium difficile and its cytotoxins. Isolates from all patients belonged to serogroup C, were highly resistant to lincomycin, and exhibited the same restriction pattern by pulsed-field gel electrophoresis. The outbreak ended after treatment with lincomycin was discontinued and hygiene control measures were implemented.