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Antimicrobial Resistance & Infection Control
Published in:

Open Access 01-12-2017 | Research

Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections

Authors: Jacqueline Färber, Sebastian Illiger, Fabian Berger, Barbara Gärtner, Lutz von Müller, Christoph H. Lohmann, Katja Bauer, Christina Grabau, Stefanie Zibolka, Dirk Schlüter, Gernot Geginat

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

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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.
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Metadata
Title
Management of a cluster of Clostridium difficile infections among patients with osteoarticular infections
Authors
Jacqueline Färber
Sebastian Illiger
Fabian Berger
Barbara Gärtner
Lutz von Müller
Christoph H. Lohmann
Katja Bauer
Christina Grabau
Stefanie Zibolka
Dirk Schlüter
Gernot Geginat
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI
https://doi.org/10.1186/s13756-017-0181-4

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