Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106

Ratnayake, Lasantha; McEwen, J.; Henderson, Nikola; Nathwani, Dilip; Phillips, G.; Brown, D. J. F.; Coia, John

doi:10.1016/j.jhin.2011.06.013

Cited by 19 publications

(10 citation statements)

References 16 publications

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“…Among the predominant strains in this study, ribotypes 020, 056, and 015 were also detected among CA-CDI in England [36], whereas ribotype 106 was more prevalent overall in Scotland [37]. Notably, high frequencies of resistance to clindamycin, fluoroquinolones, and cephalosporins in ribotype 106 and associated outbreaks have been described [37, 38], indicating the need for continued surveillance for changes in the molecular epidemiology of CA-CDI to help guide prevention efforts.…”

Section: Discussionmentioning

confidence: 91%

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Guh

Adkins

et al. 2017

Open Forum Infectious Diseases

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BackgroundAn increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.MethodsWe enrolled participants from 10 US sites during October 2014–March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.ResultsOf 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure—that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13–321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01–311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77–340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76–340.05),—emergency department visit (AmOR, 17.37; 95% CI, 1.99–151.22), white race (AmOR 7.67; 95% CI, 2.34–25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20–19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24–118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27–20.79) were associated with CA-CDI.ConclusionsAntibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.

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Section: Discussionmentioning

confidence: 91%

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Guh

Adkins

et al. 2017

Open Forum Infectious Diseases

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“…Other ribotypes found in this study such as 039 and 106 are also frequently isolated from human and/or animal faecal samples (Alcalá et al., , ; Bauer et al., ; Freeman et al., ; Koene et al., ; Tickler et al., ). In particular, ribotype 106 has been implicated in outbreaks of human disease in the UK (Ratnayake et al., ) and is also relatively common in continental Europe and North America (Alcalá et al., ,; Bauer et al., ; Freeman et al., ; Tickler et al., ). We recently obtained several ribotype 106 isolates from the faeces of dogs with diverse digestive disorders (Orden et al., ).…”

Section: Discussionmentioning

confidence: 99%

Recreational sandboxes for children and dogs can be a source of epidemic ribotypes of Clostridium difficile

Orden

Neila

Blanco

et al. 2017

Zoonoses and Public Health

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Different studies have suggested that the sand of public playgrounds could have a role in the transmission of infections, particularly in children. Furthermore, free access of pets and other animals to the playgrounds might increase such a risk. We studied the presence of Clostridium difficile in 20 pairs of sandboxes for children and dogs located in different playgrounds within the Madrid region (Spain). Clostridium difficile isolation was performed by enrichment and selective culture procedures. The genetic (ribotype and amplified fragment length polymorphism [AFLP]) diversity and antibiotic susceptibility of isolates was also studied. Overall, 52.5% (21/40) of samples were positive for the presence of C. difficile. Eight of the 20 available isolates belonged to the toxigenic ribotypes 014 (n = 5) and 106 (n = 2), both regarded as epidemic, and CD047 (n = 1). The other 12 isolates were non-toxigenic, and belonged to ribotypes 009 (n = 5), 039 (n = 4), and 067, 151 and CD048 (one isolate each). Nevertheless, all isolates (even those of a same ribotype) were classified into different AFLP genotypes indicating non-relatedness. In conclusion, our results revealed the presence of epidemic ribotypes of C. difficile in children's and dog's sandboxes located nearby, which constitutes a major health risk.

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“…We identified 17 studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] on outbreaks involving C. difficile, norovirus, rotavirus, Salmonella panama, small round structured virus, or small round structured virus and small round featureless virus. The primary mode of transmission for all these pathogens is direct person-to-person contact and indirect contact with contaminated surfaces [20].…”

Section: Gastrointestinal System (Table 1)mentioning

confidence: 99%

“…The definition of ward closure varied across the studies, and ward closure lasted between 3 days and 1 month among the studies that reported length of closure. Six studies defined ward closure as prohibiting new admissions to the affected clinical area (i.e., unit/ward/bay) [21][22][23][24][25][26]. Widdowson and colleagues reported on a study that utilized a phased approach, first halting new admissions and discharging all cases, then halting all admissions and discharging all patients from the area [27].…”

Section: Gastrointestinal System (Table 1)mentioning

confidence: 99%

“…Of nine studies that reported achieving outbreak containment, six attributed it to all the measures used [21,25,26,28,31,33], two studies attributed it to multiple, but not all the measures used [27,37], and one study did not specify which measures contributed to the outcome [36]. In two studies, the reduced number of new cases of colonization and infection was attributed to all the measures used [30,32].…”

Section: Gastrointestinal System (Table 1)mentioning

confidence: 99%

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Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

Wong

Eso

et al. 2015

Syst Rev

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BackgroundThough often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment.MethodsWe searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality.ResultsWe included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted.ConclusionsWith no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0131-2) contains supplementary material, which is available to authorized users.

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Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106

Cited by 19 publications

References 16 publications

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study

Recreational sandboxes for children and dogs can be a source of epidemic ribotypes of Clostridium difficile

Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review

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