Journal Article

A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile–Associated Diarrhea with High Morbidity and Mortality

Dascal, André, Nguyen, Tuyen, Bourgault, Anne-Marie, Monczak, Yury, Frenette, Charles, Oughton, Matthew, Horn, Ruth, Fenn, Susan, Miller, Mark A, Kelly, Mirabelle, Brassard, Paul, Loo, Vivian G, René, Pierre, Dewar, Ken, Poirier, Louise, Hudson, Thomas J, Libman, Michael D, Michaud, Sophie, Vibien, Anne

2005

Overview

In the first half of 2003, the number of C. difficile infections (22.5 per 1000 admissions) increased in Quebec, Canada. This outbreak was associated with fluoroquinolone and cephalosporin use as well as an increase in C. difficile –associated mortality (to 6.9 percent) and colectomy (to 1.9 percent). The outbreak strain was found to have enhanced virulence, as suggested by the presence of binary toxin genes and the partial deletion of a toxin-repressor gene. In the first half of 2003, the number of C. difficile infections (22.5 per 1000 admissions) increased in Quebec, Canada. This outbreak was associated with fluoroquinolone and cephalosporin use as well as an increase in C. difficile –associated mortality and colectomy. Clostridium difficile is the leading cause of nosocomial infectious diarrhea. 1 The most important risk factor for C. difficile –associated diarrhea is prior antibiotic use. 2 Some patients remain asymptomatic after exposure to C. difficile, whereas illness ranging from mild diarrhea to fulminant colitis develops in others. 2 Only 1 to 5 percent of affected patients have severe disease, leading to colectomy, intensive care, or death. 3 , 4 The best-described C. difficile virulence factors are toxins A and B, encoded by the genes tcdA and tcdB, respectively. 5 Together with two regulatory genes ( tcdC and tcdD ) and a porin gene ( tcdE ), . . .

• Publisher: Massachusetts Medical Society
• Subject: Aged / Aged, 80 and over / Bacterial Proteins - genetics / Bacterial Toxins - genetics / Biological and medical sciences / Case-Control Studies / Clostridium / Clostridium difficile - classification / Clostridium difficile - genetics / Clostridium difficile - isolation & purification / Clostridium difficile - pathogenicity / Clostridium Infections - epidemiology / Clostridium Infections - microbiology / Clostridium Infections - mortality / Cross Infection - epidemiology / Cross Infection - microbiology / Cross Infection - mortality / Diarrhea / Diarrhea - epidemiology / Diarrhea - microbiology / Disease Outbreaks / Drug Resistance, Bacterial / Female / Fluoroquinolones - therapeutic use / Gene Deletion / General aspects / Health facilities / Humans / Incidence / Inflammatory bowel disease / Intensive care / Male / Medical sciences / Microbial Sensitivity Tests / Mortality / Patients / Prospective Studies / Quebec - epidemiology / Repressor Proteins - genetics / Risk Factors