Control of an outbreak of infection with the hypervirulent clostridium difficile BI strain in a University Hospital using a comprehensive " Bundle" approach

被引:189
作者
Muto, Carlene A.
Blank, Mary Kathleen
Marsh, Jane W.
Vergis, Emanuel N.
O'Leary, Mary M.
Shutt, Kathleen A.
Pasculle, Anthony W.
Pokrywka, Marian
Garcia, Juliet G.
Posey, Kathy
Roberts, Terri L.
Potoski, Brian A.
Blank, Gary E.
Simmons, Richard L.
Veldkamp, Peter
Harrison, Lee H.
Paterson, David L.
机构
[1] Univ Pittsburgh, Med Ctr, Div Hosp Epidemil & Infect Control, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Med Ctr, Dept Med, Div Infect Dis, Pittsburgh, PA USA
[3] Univ Pittsburgh, Med Ctr, Dept Pathol, Div Microbiol, Pittsburgh, PA USA
[4] Univ Pittsburgh, Med Ctr, Dept Pathol, Div Pathol, Pittsburgh, PA USA
[5] Univ Pittsburgh, Med Ctr, Dept Surg, Pittsburgh, PA USA
[6] Univ Pittsburgh, Med Ctr, Antibiot Management Program, Pittsburgh, PA 15260 USA
[7] Univ Pittsburgh, Sch Med, Pittsburgh, PA 15260 USA
[8] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA USA
[9] Univ Pittsburgh, Grad Sch Publ Hlth, Infect Dis Epidemiol Res Unit, Pittsburgh, PA USA
[10] Univ Pittsburgh, Sch Pharm, Dept Pharm & Therapeut, Pittsburgh, PA 15261 USA
关键词
D O I
10.1086/522654
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. In June 2000, the hospital-acquired Clostridium difficile (CD) infection rate in our hospital (University of Pittsburgh Medical Center-Presbyterian, Pittsburgh, PA) increased to 10.4 infections per 1000 hospital discharges (HDs); the annual rate increased from 2.7 infections per 1000 HDs to 7.2 infections per 1000 HDs and was accompanied by an increase in the frequency of severe outcomes. Forty-seven (51%) of 92 HA CD isolates in 2001 were identified as the "epidemic BI strain." A comprehensive CD infection control "bundle" was implemented to control the outbreak of CD infection. Methods. The CD infection control bundle consisted of education, increased and early case finding, expanded infection-control measures, development of a CD infection management team, and antimicrobial management. Process measures, antimicrobial usage, and hospital-acquired CD infection rates were analyzed, and CD isolates were typed. Results. The rates of compliance with hand hygiene and isolation were 75% and 68%, respectively. The CD management team evaluated a mean of 31 patients per month (11% were evaluated for moderate or severe disease). Use of antimicrobial therapy associated with increased CD infection risk decreased by 41% during the period 2003 2005 (). The aggregate rate of CD infection during the period 2001-2006 decreased to 4.8 infections per 1000 P <.001 HDs (odds ratio, 2.2; 95% confidence interval, 1.4-3.1;) and by 2006, was 3.0 infections per 1000 HDs, a P <.001 rate reduction of 71% ( odds ratio, 3.5; 95% confidence interval, 2.3-5.4;). During the period 2000-2001, P <.001 the proportion of severe CD cases peaked at 9.4% ( 37 of 393 CD infections were severe); the rate decreased to 3.1% in 2002 and further decreased to 1.0% in 2006-a 78% overall reduction ( odds ratio, 20.3; 95% confidence interval, 2.8-148.2;). In 2005, 13% of CD isolates were type BI (20% were hospital acquired), which represented a P !.001 significant reduction from 2001 (P <.001) Conclusions. The outbreak of CD infection with the BI strain in our hospital was controlled after implementing a CD infection control "bundle." Early identification, coupled with appropriate control measures, reduces the rate of CD infection and the frequency of adverse events.
引用
收藏
页码:1266 / 1273
页数:8
相关论文
共 35 条
[1]   Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001 [J].
Archibald, LK ;
Banerjee, SN ;
Jarvis, WR .
JOURNAL OF INFECTIOUS DISEASES, 2004, 189 (09) :1585-1589
[2]   Clostridium difficile-associated diarrhea outbreaks:: The name of the game is isolation and cleaning [J].
Beaulieu, M ;
Thirion, DJG ;
Williamson, D ;
Pichette, G .
CLINICAL INFECTIOUS DISEASES, 2006, 42 (05) :725-725
[3]   Lack of association between the increased incidence of Clostridium difficile-associated disease and the increasing use of alcohol-based hand rubs [J].
Boyce, John M. ;
Ligi, Cathy ;
Kohan, Cindy ;
Dumigan, Diane ;
Havill, Nancy L. .
INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 2006, 27 (05) :479-483
[4]  
BROWN E, 1990, INFECT CONT HOSP EP, V11, P283
[5]  
*CDCP, 1975, HHS PUBL CDC
[6]   DEVELOPMENT OF A RAPID AND EFFICIENT RESTRICTION-ENDONUCLEASE ANALYSIS TYPING SYSTEM FOR CLOSTRIDIUM-DIFFICILE AND CORRELATION WITH OTHER TYPING SYSTEMS [J].
CLABOTS, CR ;
JOHNSON, S ;
BETTIN, KM ;
MATHIE, PA ;
MULLIGAN, ME ;
SCHABERG, DR ;
PETERSON, LR ;
GERDING, DN .
JOURNAL OF CLINICAL MICROBIOLOGY, 1993, 31 (07) :1870-1875
[7]   Hospital-wide restriction of clindamycin:: Effect on the incidence of Clostridium difficile-associated diarrhea and cost [J].
Climo, MW ;
Israel, DS ;
Wong, ES ;
Williams, D ;
Coudron, P ;
Markowitz, SM .
ANNALS OF INTERNAL MEDICINE, 1998, 128 (12) :989-+
[8]  
DRAPKIN MS, 1985, ARCH SURG-CHICAGO, V120, P1321
[9]   Molecular epidemiology of endemic Clostridium difficile infection and the significance of subtypes of the United Kingdom epidemic strain (PCR ribotype 1) [J].
Fawley, WN ;
Parnell, P ;
Verity, P ;
Freeman, J ;
Wilcox, MH .
JOURNAL OF CLINICAL MICROBIOLOGY, 2005, 43 (06) :2685-2696
[10]   CDC DEFINITIONS FOR NOSOCOMIAL INFECTIONS, 1988 [J].
GARNER, JS ;
JARVIS, WR ;
EMORI, TG ;
HORAN, TC ;
HUGHES, JM .
AMERICAN JOURNAL OF INFECTION CONTROL, 1988, 16 (03) :128-140