Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Revista do Instituto de Medicina Tropical de São Paulo |
Texto Completo: | https://www.revistas.usp.br/rimtsp/article/view/31320 |
Resumo: | The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired. |
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Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital Pseudo-surto de diarréia associada a Clostridium difficile (DACD) em hospital terciário Clostridium difficilepseudo-outbreakmolecular typingcommunity-acquired The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired. O objetivo deste estudo foi descrever um pseudo-surto de C. difficile em um hospital após a troca do método de detecção de toxina. Em fevereiro de 2002 houve dois casos de DACD e em março ocorreram sete casos, que coincidiram com a mudança de teste (que detectava apenas toxina A e passou a detectar toxinas A e B). Foi suspeitado que houvesse um surto e vigilância ativa e reforço educacional para os profissionais de saúde foi implantado. Um caso de DACD foi definido como um paciente com início abrupto de diarréia (>; 3 episódios de fezes líquidas) e um teste positivo. Os casos foram classificados como de aquisição comunitária ou hospitalar. Foram colhidas fezes para cultura para C. difficile e os isolados foram tipados por AP-PCR. De março de 2002 a dezembro de 2003 houve 138 casos de DACD: 70% foram hospitalares e, entre os 30% de casos comunitários, a maioria (81%) foi de pacientes provenientes diretamente da comunidade (50% não tinham histórico de internação). Cinquenta e dois por cento dos casos de DCAD hospitalar e 94% de casos na admissão haviam utilizado antimicrobianos. A incidência de DCAD em pacientes internados foi de 3,3/100 pacientes e na admissão foi 6,1/1000 pacientes. Dezesseis isolados foram tipados e apresentaram 13 perfis diferentes. Em conclusão, o aumento de DACD no nosso estudo ocorreu por uma mudança de método diagnóstico e não devido a um surto como foi suspeitado inicialmente. A incidência em pacientes internados foi muito inferior ao que já foi relatado em surtos. Houve 13 perfis moleculares sugerindo que não ocorreu um surto. DACD foi, em grande parte, de aquisição comunitária. Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo2010-06-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/rimtsp/article/view/31320Revista do Instituto de Medicina Tropical de São Paulo; Vol. 52 No. 3 (2010); 133-137 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 52 Núm. 3 (2010); 133-137 Revista do Instituto de Medicina Tropical de São Paulo; v. 52 n. 3 (2010); 133-137 1678-99460036-4665reponame:Revista do Instituto de Medicina Tropical de São Pauloinstname:Instituto de Medicina Tropical (IMT)instacron:IMTenghttps://www.revistas.usp.br/rimtsp/article/view/31320/33205Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Pauloinfo:eu-repo/semantics/openAccessDias, M. Beatriz SouzaYamashiro, JulianaBorrasca, Vera L.Stempliuk, Valeska A.Araújo, Maria Rita E.Costa, Silvia F.Levin, Anna S.2012-07-07T19:31:10Zoai:revistas.usp.br:article/31320Revistahttp://www.revistas.usp.br/rimtsp/indexPUBhttps://www.revistas.usp.br/rimtsp/oai||revimtsp@usp.br1678-99460036-4665opendoar:2022-12-13T16:51:59.804071Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)true |
dc.title.none.fl_str_mv |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital Pseudo-surto de diarréia associada a Clostridium difficile (DACD) em hospital terciário |
title |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
spellingShingle |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital Dias, M. Beatriz Souza Clostridium difficile pseudo-outbreak molecular typing community-acquired |
title_short |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
title_full |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
title_fullStr |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
title_full_unstemmed |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
title_sort |
Pseudo-outbreak of Clostridium difficile associated diarrhea (CDAD) in a tertiary-care hospital |
author |
Dias, M. Beatriz Souza |
author_facet |
Dias, M. Beatriz Souza Yamashiro, Juliana Borrasca, Vera L. Stempliuk, Valeska A. Araújo, Maria Rita E. Costa, Silvia F. Levin, Anna S. |
author_role |
author |
author2 |
Yamashiro, Juliana Borrasca, Vera L. Stempliuk, Valeska A. Araújo, Maria Rita E. Costa, Silvia F. Levin, Anna S. |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Dias, M. Beatriz Souza Yamashiro, Juliana Borrasca, Vera L. Stempliuk, Valeska A. Araújo, Maria Rita E. Costa, Silvia F. Levin, Anna S. |
dc.subject.por.fl_str_mv |
Clostridium difficile pseudo-outbreak molecular typing community-acquired |
topic |
Clostridium difficile pseudo-outbreak molecular typing community-acquired |
description |
The objective of this study was to describe a pseudo-outbreak of C. difficile in a hospital, following a change in the method used to detect the toxin. In February 2002, there were two cases of CDAD and in March 7 occurred, coinciding with a change of the test (from detection of toxin A to toxin A/B). An outbreak was suspected. Active surveillance and education of staff were started. A CDAD case was defined as a patient with acute onset of diarrhea (³ three episodes of liquid stools) and a positive stool test. They were classified as hospital or community-acquired. Stool samples were also collected for C. difficile culture and isolates were typed using AP-PCR. From March 2002 through December 2003 there were 138 cases of CDAD: 70% were hospital-acquired and among the 30% with CDAD present on admission, most (81%) came directly from the community (50% had no history of hospitalization). Fifty-two percent of hospital-acquired CDAD and 94% of cases on admission had already used antibiotics. The incidence of CDAD in hospitalized patients during surveillance was 3.3 per 1000 patient-admissions. The incidence of CDAD present on admission was 6.1/1000 patients. Sixteen isolates were typed and presented 13 different profiles. In conclusion, the CDAD increase in our study occurred due to change in diagnostic methods and not due to an outbreak, as suspected initially. The incidence in hospitalized patients was much lower than in reported outbreaks. There were 13 molecular types suggesting that an outbreak did not occur. CDAD was largely community-acquired. |
publishDate |
2010 |
dc.date.none.fl_str_mv |
2010-06-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/31320 |
url |
https://www.revistas.usp.br/rimtsp/article/view/31320 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/31320/33205 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
dc.source.none.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo; Vol. 52 No. 3 (2010); 133-137 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 52 Núm. 3 (2010); 133-137 Revista do Instituto de Medicina Tropical de São Paulo; v. 52 n. 3 (2010); 133-137 1678-9946 0036-4665 reponame:Revista do Instituto de Medicina Tropical de São Paulo instname:Instituto de Medicina Tropical (IMT) instacron:IMT |
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Instituto de Medicina Tropical (IMT) |
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IMT |
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IMT |
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Revista do Instituto de Medicina Tropical de São Paulo |
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Revista do Instituto de Medicina Tropical de São Paulo |
repository.name.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT) |
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