Abstract
BackgroundHere 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.MethodsEpidemiological 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.ResultsThe 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.ConclusionThe successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections.
Highlights
We describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections
After implementation of an intensified antibiotic stewardship program in quarter 3/2015 the CDI incidence dropped in the first quarter 2016 to no case per quarter which was significantly below the mean CDI incidence of the 4 previous quarters minus Moving average plus/minus standard deviation (SD) of 2.13 infections per 1,000 hospital bed days (Fig. 1)
Here we report an increased incidence of CDI mainly caused by C. difficile ribotype 027 (RT027) with an elevated minimal inhibitory concentrations (MIC) for rifampicin among patients suffering from osteoarticular infections and the successful control of CDI by implementation of an antibiotic stewardship program focused on this difficult to treat group of patients
Summary
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. As a spore-forming bacterium, C. difficile has the ability to persist and to remain infectious in the environment for extended periods of time. The main risk factors for development of C. difficile infection (CDI) are (i) previous. Färber et al Antimicrobial Resistance and Infection Control (2017) 6:22 data on the CDI incidence among patients with prosthetic joint infections are scarce [10]. A much higher CDI incidence of 7.1%, has been reported after open reduction and internal fixation of intertrochanteric femoral fractures, which in all cases occurred after previous antibiotic therapy [11]
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