[Nosocomial diarrhea outbreak due to Clostridium difficile in a vascular surgery department].
BACKGROUND
Clostridium difficile is considered the most common cause of nosocomial-acquired diarrhea. In Spain this condition is rarely reported.


METHODS
Over a five-month period, 35 episodes of C. difficile diarrhea were diagnosed by toxin A detection in stool samples. Case-control studies were designed to assess risk factors for the outbreak. Twelve cases from the vascular surgery department were compared with 24 randomized controls, patients admitted to the same ward during this period, but without diarrhea. Statistical comparisons (SPSS software) were performed with the Student's t and X2 tests (OR with 95% CI).


RESULTS
Overall incidence was 3.42 episodes: 48 episodes/1000 admissions to vascular surgery. Among the total, 80% had received antibiotics before admission and the mean number of antibiotics administered was 2.91 per patient. Comparative analyses disclosed that the cases had received a larger number of antibiotics during hospitalization (p 5 0.000) and in the two months before admission (p 5 0.031) than the controls. Clindamycin administered alone (p 5 0.001) or associated with aztreonam (p 0.000) were the most frequently used antibiotic treatments.


CONCLUSIONS
C. difficile diarrhea is common in our setting. Diagnosis requires a high index of suspicion. We attribute the nosocomial outbreak in our vascular surgery department to broad-spectrum antibiotic use (clindamycin and aztreonam). Surveillance, together with restriction of antibiotic use was effective for control.
Servicios de Medicina Interna-Enfermedades Infecciosas. Cristal-Piñor Hospitais. Ourense. España.
Rosario
R
Pazos
Ana
A
Isusi
Ricardo
R
Fernández
Luis
L
Barbeito
Ana
A
Bravo
Isabel
I
Cantón
Pilar
P
Gayoso
Ramón
R
Lebrato
D000368:Aged; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000382:microbiology; D011897:Random Allocation; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014656:Vascular Surgical Procedures