title: An outbreak case of Clostridium difficile-associated diarrhea among elderly inpatients of an intensive care unit of a tertiary hospital in Rio de Janeiro, Brazil.
abstract: The aim of this study was to investigate Clostridium difficile-associated diarrhea (CDAD) in an intensive care unit (ICU) of a tertiary hospital in Rio de Janeiro, Brazil, and to characterize epidemiologically C. difficile strains obtained from an outbreak of CDAD. Within almost a 4-year surveillance period, CDAD incidence was determined for the first time in Brazil, and a 3-fold increase was observed in the average rate of CDAD, featuring an outbreak. About 80% of the patients were over 65 years. The main antibiotic that could be probably associated to CDAD was piperacillin/tazobactam. Four toxigenic strains were isolated, 3 from stools and 1 from environmental samples. They were all resistant to clindamycin and fluoroquinolones. Fingerprinting analysis revealed their distribution between 2 different polymerase chain reaction ribotypes, with one of them being exclusively found in Brazil. It was possible to detect cross-infection and environmental contamination in the ICU. Our results highlight the importance of a continuous CDAD surveillance in the hospitals, especially when a risk group is exposed.
authors.affiliation: Laboratório de Biologia de Anaeróbios, Instituto de Microbiologia Professor Paulo de Góes, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, RJ 21941-590, Brazil. ilana@ioc.fiocruz.br
authors.forename: Ilana Teruszkin
authors.initials: IT
authors.lastname: Balassiano
authors.forename: Joaquim
authors.initials: J
authors.lastname: Dos Santos-Filho
authors.forename: Márcia Pinto Barros
authors.initials: MP
authors.lastname: de Oliveira
authors.forename: Maria Catarina
authors.initials: MC
authors.lastname: Ramos
authors.forename: Andre M
authors.initials: AM
authors.lastname: Japiassu
authors.forename: Alessandro Mendonça
authors.initials: AM
authors.lastname: Dos Reis
authors.forename: Jon S
authors.initials: JS
authors.lastname: Brazier
authors.forename: Eliane
authors.initials: E
authors.lastname: de Oliveira Ferreira
authors.forename: Regina Maria Cavalcanti Pilotto
authors.initials: RM
authors.lastname: Domingues
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016133:Polymerase Chain Reaction / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D021521:Ribotyping
chemical_list: D000900:Anti-Bacterial Agents