Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital

Authors

  • M. Beatriz Souza Dias Hospital Sírio Libanês; Infection Control Unit
  • Juliana Yamashiro University of São Paulo; Hospital das Clínicas; Department of Infection Control
  • Vera L. Borrasca Hospital Sírio Libanês; Infection Control Unit
  • Valeska A. Stempliuk Instituto Sírio-Libanês de Ensino e Pesquisa
  • Maria Rita E. Araújo Hospital da Beneficência Portuguesa; Laboratory of Microbiology
  • Silvia F. Costa University of São Paulo; Department of Infectious Diseases and LIM-54
  • Anna S. Levin University of São Paulo; Department of Infectious Diseases and LIM-54

Keywords:

Clostridium difficile, pseudo-outbreak, molecular typing, community-acquired

Abstract

The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired.

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Published

2010-06-01

Issue

Section

Bacteriology

How to Cite

Dias, M. B. S., Yamashiro, J., Borrasca, V. L., Stempliuk, V. A., Araújo, M. R. E., Costa, S. F., & Levin, A. S. (2010). Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital . Revista Do Instituto De Medicina Tropical De São Paulo, 52(3), 133-137. https://www.revistas.usp.br/rimtsp/article/view/31320