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

  • Mamoon A. Aldeyab (a1), Michael J. Devine (a2), Peter Flanagan (a3), Michael Mannion (a3), Avril Craig (a2), Michael G. Scott (a3), Stephan Harbarth (a4), Nathalie Vernaz (a5), Elizabeth Davies (a3), Jon S. Brazier (a6), Brian Smyth (a7), James C. McElnay (a1), Brendan F. Gilmore (a8), Geraldine Conlon (a3), Fidelma A. Magee (a3), Feras W. Darwish Elhajji (a1), Shaunagh Small (a3), Collette Edwards (a3), Chris Funston (a3) and Mary P. Kearney (a3)...



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.


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


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


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).


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.


Corresponding author

Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, United Kingdom (


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