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Multi-hospital outbreak of Clostridium difficile associated disease mediated by ermB+/tcdA+/tcdB+ epidemic clone Observations following the restriction of clindamycin



Multi-hospital outbreak of Clostridium difficile associated disease mediated by ermB+/tcdA+/tcdB+ epidemic clone Observations following the restriction of clindamycin



Abstracts of the Interscience Conference on Antimicrobial Agents & Chemotherapy 43: 366



Background: Reports of major nosocomial outbreaks of Clostridium difficile-associated disease are increasingly common throughout the world, attributed most commonly to patterns in antibiotic dispensing and the deterioration of physical plant maintenance within the hospital setting. The Calgary Health Region experienced a multi-hospital outbreak of C. difficile associated disease involving approximately 1000 patients in 2000-2002. To study the epidemic, C. difficile strains were recovered in the latter half of the outbreak, and following the restriction of clindamycin use in hospitalized patients. Methods: Eight hundred single-patient isolates of C. difficile were analyzed over the course of a three year period. Isolates were characterized using PCR ribotyping, and specific probes to assess the presence of the ermB macrolide resistance determinant and tcdA/tcdB clostridial toxin genes. Results: At the peak of the outbreak in April to May 2001, a single ermB+/tcdA+/tcdB+ clone was identified in 59/101 (59%) of hospital isolates, and 11/54 (20%) of community isolates. Following clindamycin restriction, the relative abundance of this strain has diminished, such that the epidemic strain now accounts for 32% of clinical CDAD in the Calgary Health Region in the first quarter of 2003. Conclusions: The reduction of clonal dominance following decreased antibiotic selection pressure is further evidence to support the utility of antibiotic restriction policies.

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Accession: 035349240

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