Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections
Abstract Background Here we describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of C. difficile and to evaluate the impact of general infection control measures and antibiotic s...
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| Format: | Article |
| Language: | English |
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BMC
2017-02-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13756-017-0181-4 |
| _version_ | 1828931838443257856 |
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| author | Jacqueline Färber Sebastian Illiger Fabian Berger Barbara Gärtner Lutz von Müller Christoph H. Lohmann Katja Bauer Christina Grabau Stefanie Zibolka Dirk Schlüter Gernot Geginat |
| author_facet | Jacqueline Färber Sebastian Illiger Fabian Berger Barbara Gärtner Lutz von Müller Christoph H. Lohmann Katja Bauer Christina Grabau Stefanie Zibolka Dirk Schlüter Gernot Geginat |
| author_sort | Jacqueline Färber |
| collection | DOAJ |
| description | Abstract Background Here we describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of C. difficile and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of CDI. Methods Epidemiological analysis included typing of C. difficile strains and analysis of possible patient to patient transmission. Infection control measures comprised strict isolation of CDI patients, additional hand washings, and intensified environmental cleaning with sporicidal disinfection. In addition an antibiotic stewardship program was implemented in order to prevent the use of CDI high risk antimicrobials such as fluoroquinolones, clindamycin, and cephalosporins. Results The majority of CDI (n = 15) were caused by C. difficile ribotype 027 (RT027). Most RT027 isolates (n = 9) showed high minimal inhibitory concentrations (MIC) for levofloxacin, clindamycin, and remarkably to rifampicin, which were all used for the treatment of osteoarticular infections. Epidemiological analysis, however, revealed no closer genetic relationship among the majority of RT027 isolates. The incidence of CDI was reduced only when a significant reduction in the use of fluoroquinolones (p = 0.006), third generation cephalosporins (p = 0.015), and clindamycin (p = 0.001) was achieved after implementation of an intensified antibiotic stewardship program which included a systematic review of all antibiotic prescriptions. Conclusion The successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections. |
| first_indexed | 2024-12-14T00:53:38Z |
| format | Article |
| id | doaj.art-492263a99fae425eb3de4b0bf1de6a18 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-14T00:53:38Z |
| publishDate | 2017-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-492263a99fae425eb3de4b0bf1de6a182022-12-21T23:23:42ZengBMCAntimicrobial Resistance and Infection Control2047-29942017-02-016111210.1186/s13756-017-0181-4Management of a cluster of Clostridium difficile infections among patients with osteoarticular infectionsJacqueline Färber0Sebastian Illiger1Fabian Berger2Barbara Gärtner3Lutz von Müller4Christoph H. Lohmann5Katja Bauer6Christina Grabau7Stefanie Zibolka8Dirk Schlüter9Gernot Geginat10Institute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University of MagdeburgDepartment of Orthopedic Surgery, Otto-von-Guericke University of MagdeburgInstitute of Medical Microbiology and Hygiene, Consultant Laboratory for Clostridium difficile, University of SaarlandInstitute of Medical Microbiology and Hygiene, Consultant Laboratory for Clostridium difficile, University of SaarlandInstitute for Laboratory Medicine, Microbiology and Hygiene, Christophorus KlinikenDepartment of Orthopedic Surgery, Otto-von-Guericke University of MagdeburgInstitute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University of MagdeburgCentral pharmacy, Otto-von-Guericke University of MagdeburgCentral pharmacy, Otto-von-Guericke University of MagdeburgInstitute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University of MagdeburgInstitute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University of MagdeburgAbstract Background Here we describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of C. difficile and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of CDI. Methods Epidemiological analysis included typing of C. difficile strains and analysis of possible patient to patient transmission. Infection control measures comprised strict isolation of CDI patients, additional hand washings, and intensified environmental cleaning with sporicidal disinfection. In addition an antibiotic stewardship program was implemented in order to prevent the use of CDI high risk antimicrobials such as fluoroquinolones, clindamycin, and cephalosporins. Results The majority of CDI (n = 15) were caused by C. difficile ribotype 027 (RT027). Most RT027 isolates (n = 9) showed high minimal inhibitory concentrations (MIC) for levofloxacin, clindamycin, and remarkably to rifampicin, which were all used for the treatment of osteoarticular infections. Epidemiological analysis, however, revealed no closer genetic relationship among the majority of RT027 isolates. The incidence of CDI was reduced only when a significant reduction in the use of fluoroquinolones (p = 0.006), third generation cephalosporins (p = 0.015), and clindamycin (p = 0.001) was achieved after implementation of an intensified antibiotic stewardship program which included a systematic review of all antibiotic prescriptions. Conclusion The successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections.http://link.springer.com/article/10.1186/s13756-017-0181-4C. difficileRibotype 027RifampicinOsteoarticular infectionsAntibiotic stewardship |
| spellingShingle | Jacqueline Färber Sebastian Illiger Fabian Berger Barbara Gärtner Lutz von Müller Christoph H. Lohmann Katja Bauer Christina Grabau Stefanie Zibolka Dirk Schlüter Gernot Geginat Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections Antimicrobial Resistance and Infection Control C. difficile Ribotype 027 Rifampicin Osteoarticular infections Antibiotic stewardship |
| title | Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections |
| title_full | Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections |
| title_fullStr | Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections |
| title_full_unstemmed | Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections |
| title_short | Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections |
| title_sort | management of a cluster of clostridium difficile infections among patients with osteoarticular infections |
| topic | C. difficile Ribotype 027 Rifampicin Osteoarticular infections Antibiotic stewardship |
| url | http://link.springer.com/article/10.1186/s13756-017-0181-4 |
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