A Large Outbreak of Clostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use

@article{Muto2005ALO,
  title={A Large Outbreak of Clostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use},
  author={C. Muto and M. Pokrywka and K. Shutt and A. Mendelsohn and K. Nouri and K. Posey and Terri L. Roberts and Karen S. Croyle and Sharon Krystoflak and Sujata Patel-Brown and A. Pasculle and D. Paterson and M. Saul and L. Harrison},
  journal={Infection Control \&\#x0026; Hospital Epidemiology},
  year={2005},
  volume={26},
  pages={273 - 280}
}
Abstract Background and Objective: Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1,000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and… Expand
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TLDR
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References

SHOWING 1-10 OF 68 REFERENCES
Risk factors for the development of Clostridium difficile-associated diarrhea during a hospital outbreak.
TLDR
The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C diffiile- associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Expand
Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use.
  • R. Gaynes, D. Rimland, +4 authors F. Tenover
  • Medicine
  • Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
  • 2004
TLDR
It was concluded that an outbreak of CDAD in an LTCF was associated with a formulary change from levofloxacin to gatifloxAcin, and the rate ofCDAD in the LTCf decreased after a change back to levof loxacins. Expand
Risk factors for Clostridium difficile toxin-associated diarrhea.
TLDR
Hospital antibiotic usage patterns showed concurrent increased use of third-generation cephalosporins, and intravenous vancomycin and metronidazole, and hospital control measures included encouraging earlier isolation and treatment of suspected cases and formulary restriction of clindamycin, with use of metronodazole for therapy of anaerobic infections. Expand
Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients.
TLDR
C. difficile was a common Nosocomial infection on this ward, resulting in asymptomatic carriage more often than diarrhea and accounting for one-fifth of all cases of nosocomial diarrhea. Expand
Clinical characteristics and antibiotic utilization in surgical patients with Clostridium difficile-associated diarrhea.
TLDR
The high crude mortality rate associated withCDAD suggests that this may be a significant predictor of poor outcome among infected surgical patients, and prophylactic antibiotics used commonly but not classically associated with CDAD frequently precipitate this infection. Expand
Epidemiology, clinical manifestations, and outcome of Clostridium difficile-associated diarrhea.
TLDR
Morbidity and mortality associated with CDAD is significant, is worse in debilitated older nursing home patients, and is more likely to occur in hospitalizations lasting longer than 4 wk. Expand
Risk factors for Clostridium difficile cytotoxin-positive diarrhea after control for horizontal transmission.
TLDR
It was found that the clindamycin and third-generation cephalosporins were risk factors for C difficile-associated diarrhea after controlling for horizontal transmission, and was a better explanation for an outbreak on a surgery ward than does surgery itself. Expand
Risk factors for Clostridium difficile cytotoxin-positive diarrhea after control for horizontal transmission.
  • R. Zimmerman
  • Medicine
  • Infection control and hospital epidemiology
  • 1991
TLDR
It is found that the clindamycin and third-generation cephalosporins were risk factors for C difficile-associated diarrhea after controlling for horizontal transmission. Expand
Management and control of a large outbreak of diarrhoea due to Clostridium difficile.
TLDR
In the six-month period 1 November 1991 to 1 May 1992 175 patients developed diarrhoea due to Clostridium difficile in three hospitals in Manchester, UK, and there has been a substantial and sustained decrease in the number of new cases. Expand
Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control.
TLDR
Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline, and only exposure to antibiotics and prior respiratory tract infections were found to be significant. Expand
...
1
2
3
4
5
...