JSTOR: Infection Control and Hospital Epidemiology, Vol. 26, No. 3 (March 2005), pp. 273-280

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Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America

Article DOI: 10.1086/502539

Stable URL: http://www.jstor.org/stable/10.1086/502539

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Original Articles

A Large Outbreak of Clostridium difficile‐Associated Disease With an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use

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Abstract
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Abstract(back to top)

BACKGROUND AND OBJECTIVE. Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1,000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and characterize the outbreak

METHODS. A retrospective case–control study of casepatients with C. difficile infection from January 2000 through April 2001 and control‐patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed.

RESULTS. On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI₉₅], 1.9–12.0), ceftriaxone (OR, 5.4; CI₉₅, 1.8–15.8), and levofloxacin (OR, 2.0; CI₉₅, 1.2–3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P < .001); 59% of case‐patients and 41% of control‐patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes.

CONCLUSIONS. Exposure to levofloxacin was an independent risk factor for C. difficile–associated diarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak.

Bibliographic Information(back to top)

A Large Outbreak of Clostridium difficile‐Associated Disease With an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use
Carlene A. Muto , MD, MS, Marian Pokrywka , MPH, BS, CIC, Kathleen Shutt , MS, Aaron B. Mendelsohn , PhD, Kathy Nouri , MPH, RN, BSN, CIC, Kathy Posey , MPH, BS, CIC, Terri Roberts , BS, CIC, Karen Croyle , BS, CIC, Sharon Krystofiak , MPH, MS, CIC, Sujata Patel‐Brown , BS, A. William Pasculle , ScD, David L. Paterson , MD, Melissa Saul , MS and Lee H. Harrison , MD
Infection Control and Hospital Epidemiology
Vol. 26, No. 3 (March 2005) (pp. 273-280)

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Carlene A. Muto , MD, MS; Marian Pokrywka , MPH, BS, CIC; Kathleen Shutt , MS; Aaron B. Mendelsohn , PhD; Kathy Nouri , MPH, RN, BSN, CIC; Kathy Posey , MPH, BS, CIC; Terri Roberts , BS, CIC; Karen Croyle , BS, CIC; Sharon Krystofiak , MPH, MS, CIC; Sujata Patel‐Brown , BS; A. William Pasculle , ScD; David L. Paterson , MD; Melissa Saul , MS; Lee H. Harrison , MD

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Notes

Dr. Muto, Ms. Pokrywka, Ms. Nouri, Ms. Posey, Ms. Roberts, Ms. Croyle, and Ms. Krystofiak are from the Division of Hospital Epidemiology and Infection Control, and Dr. Pasculle is from the Division of Microbiology, University of Pittsburgh Medical Center, Presbyterian Campus, Pittsburgh, Pennsylvania. Dr. Muto, Ms. Shutt, Ms. Patel‐Brown, Dr. Paterson, and Dr. Harrison are from the Infectious Diseases Epidemiology Research Unit, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, Pennsylvania. Dr. Mendelsohn is from the Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania. Dr. Pasculle is also from the Department of Pathology and Ms. Saul is from the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.Address reprint requests to Carlene A. Muto, MD, MS, University of Pittsburgh Medical Center (UPMC‐P), 1215 Kaufmann Building, Pittsburgh, PA 15213. mutoca@msx.upmc.eduSupported in part by a Research Career Award (K24 AI52788 to Dr. Harrison) from the National Institute of Allergy and Infectious Diseases.The authors thank Susan Sambol for assistance with molecular subtyping of outbreak isolates, and Kim Coley for providing the antimicrobial utilization data.

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Stable URL: http://www.jstor.org/stable/4484591
Clostridium difficile: Responding to a New Threat From an Old Enemy •
L. Clifford McDonald , MD, FACP
Infection Control and Hospital Epidemiology
Vol. 26, No. 8 (August 2005) pp. 672-675
Stable URL: http://www.jstor.org/stable/10.1086/502600

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