An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study

Autor: Marije K. Bomers, Yvette H. van Beurden, Christina M. J. E. Vandenbroucke-Grauls, Cornelis W. Knetsch, Robin van Houdt, A.M. Kaiser, Olaf M. Dekkers, Armand R. J. Girbes, Chris J. J. Mulder
Přispěvatelé: Gastroenterology and hepatology, AII - Infectious diseases, Internal medicine, ICaR - Circulation and metabolism, Medical Microbiology and Infection Prevention, Intensive care medicine
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Male
Nosocomial Infections
lcsh:Medicine
Artificial Gene Amplification and Extension
030501 epidemiology
Ribotyping
Disease Outbreaks
law.invention
Hospitals
University
0302 clinical medicine
Risk Factors
Antibiotics
law
Epidemiology
Medicine and Health Sciences
Medicine
030212 general & internal medicine
lcsh:Science
Decontamination
Netherlands
Aged
80 and over
Cross Infection
Multidisciplinary
Antimicrobials
Incidence
Drugs
Middle Aged
Clostridium difficile
University hospital
Intensive care unit
Hospitals
Intensive Care Units
Infectious Diseases
Amplified Fragment Length Polymorphism
Female
Anatomy
0305 other medical science
Research Article
medicine.medical_specialty
Clostridium Difficile
Selective decontamination
Research and Analysis Methods
Microbiology
03 medical and health sciences
Microbial Control
Humans
Molecular Biology Techniques
Intensive care medicine
Molecular Biology
Aged
Pharmacology
Bacteria
Clostridioides difficile
business.industry
Gut Bacteria
lcsh:R
Organisms
Case-control study
Biology and Life Sciences
Outbreak
Length of Stay
Penicillin
Gastrointestinal Tract
Health Care
Health Care Facilities
Case-Control Studies
Emergency medicine
Clostridium Infections
Digestive tract
lcsh:Q
business
Digestive System
Zdroj: PLoS ONE, 11(8). Public Library of Science
van Beurden, Y H, Dekkers, O M, Bomers, M K, Kaiser, A M, van Houdt, R, Knetsch, C W, Girbes, A R J, Mulder, C J J & Vandenbroucke-Grauls, C M J E 2016, ' An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study ', PLoS ONE, vol. 11, no. 8 . https://doi.org/10.1371/journal.pone.0160778
PLoS ONE, 11(8)
PLoS ONE, Vol 11, Iss 8, p e0160778 (2016)
PLoS ONE
ISSN: 1932-6203
DOI: 10.1371/journal.pone.0160778
Popis: Background An outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study. Methods Cases (n = 79), diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316). Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10) was genotyped by Whole Genome Sequencing (WGS). Findings WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates). Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU) (OR: 2.4, 95% CI 1.0–5.6), longer length of stay (LOS), and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1–0.6). Analysis of patients who stayed at the ICU (35 cases; 51 controls), indicated that the use of selective decontamination of the digestive tract (SDD) and a longer LOS in the ICU were associated with CDI risk. Interpretation In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.
Databáze: OpenAIRE
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