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Multihospital Outbreak of Clostridium difficile Ribotype 027 Infection: Epidemiology and Analysis of Control Measures

Published online by Cambridge University Press:  02 January 2015

Mamoon A. Aldeyab
Affiliation:
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
Michael J. Devine
Affiliation:
Northern Health and Social Services Board (currently Public Health Agency), County Hall, Ballymena, Northern Ireland, United Kingdom
Peter Flanagan
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Michael Mannion
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Avril Craig
Affiliation:
Northern Health and Social Services Board (currently Public Health Agency), County Hall, Ballymena, Northern Ireland, United Kingdom
Michael G. Scott
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Stephan Harbarth
Affiliation:
Infection Control Program, University of Geneva Hospitals and Medical School, Geneva, Switzerland
Nathalie Vernaz
Affiliation:
Pharmacy Department, University of Geneva Hospitals and Medical School, Geneva, Switzerland
Elizabeth Davies
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Jon S. Brazier
Affiliation:
Anaerobe Reference Laboratory, Public Health Wales, Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
Brian Smyth
Affiliation:
Health Protection Agency Communicable Disease Surveillance Centre (Northern Ireland) (currently Public Health Agency), Belfast, Northern Ireland, United Kingdom
James C. McElnay
Affiliation:
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
Brendan F. Gilmore
Affiliation:
Biomaterials and Drug Delivery Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
Geraldine Conlon
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Fidelma A. Magee
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Feras W. Darwish Elhajji
Affiliation:
Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
Shaunagh Small
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Collette Edwards
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Chris Funston
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Mary P. Kearney
Affiliation:
Northern Health and Social Care Trust, Ballymena, Northern Ireland, United Kingdom
Corresponding
E-mail address:

Abstract

Objective.

To report a large outbreak of Clostridium difficile infection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.

Design.

Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.

Interventions.

Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.

Results.

A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction between C. difficile ribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months; P = .003).

Conclusion.

These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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