Nosocomial outbreak ofClostridium difficile diarrhea in a pediatric service

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.

Infection control measures to limit the spread of Clostridium difficile

“…In total, 36 outbreaks caused by C. difficile are currently filed in the Outbreak Database [24]. In 19 of these, the route of transmission could not be determined or was not described by the authors [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. In the remaining 17, pathogen spread occurred 'by contact' via carriage of spores on the hands of staff [12,[49][50][51][52][53][54][55][56][57][58][59][60], by patient-to-patientspread [13,52,54,59,61,62], or indirectly from the contaminated environment [15,49,50,54,55,57,60].…”

New PCR ribotypes of Clostridium difficile detected in children in Brazil

“…Pediatric C. difficile disease seems, as in adults, to be a consequence of the disturbance of the normal protective intestinal microflora (Lawson and Welch 1993;Wilson 1993) by antibiotics, other medications or surgery (Farrell and La Mont 2000;McFarland 2000). In pediatric outbreaks caused by C. difficile (Ferroni et al 1997), the occurrence of severe complications and high mortality rates has been observed. The occurrence of children infected with C. difficile and presenting Hirschsprunǵ s disease has been reported (Qualman et al 1990).…”

National Clostridium difficile Standards Group: Report to the Department of Health

“…35 There have also been case reports of CDAD associated with levofloxacin (a quinolone) in elderly patients, 170 and lincomycin associated with a paediatric outbreak of CDAD. 171 Prescribing behaviour and formularies There are numerous examples of restrictive antibiotic policies associated with reduction in rates of CDAD. 158,159,162,163 As with infection control measures, the key to success will be ensuring compliance with these guidelines.…”