Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals - PubMed (original) (raw)
. 1999 Nov 25;341(22):1645-51.
doi: 10.1056/NEJM199911253412203.
M H Samore, K A Farrow, G E Killgore, F C Tenover, D Lyras, J I Rood, P DeGirolami, A L Baltch, M E Rafferty, S M Pear, D N Gerding
Affiliations
- PMID: 10572152
- DOI: 10.1056/NEJM199911253412203
Free article
Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals
S Johnson et al. N Engl J Med. 1999.
Free article
Abstract
Background: Large outbreaks of diarrhea caused by a newly recognized strain of Clostridium difficile occurred in four hospitals located in different parts of the United States between 1989 and 1992. Since frequent use of clindamycin was associated with the outbreak in one of the hospitals, we examined the resistance genes of the epidemic-strain isolates and studied the role of clindamycin use in these outbreaks.
Methods: Case-control studies were performed at three of the four hospitals to assess the relation of the use of clindamycin to C. difficile-associated diarrhea. All isolates of the epidemic strain and representative isolates of other strains identified during each outbreak were tested for susceptibility to clindamycin. Chromosomal DNA from these representative isolates was also analyzed by dot blot hybridization and amplification with the polymerase chain reaction (PCR) with the use of probes and primers from a previously described determinant of erythromycin resistance - the erythromycin ribosomal methylase B (ermB) gene - found in C. perfringens and C. difficile.
Results: In a stratified analysis of the case-control studies with pooling of the results according to the Mantel-Haenszel method, we found that the use of clindamycin was significantly increased among patients with diarrhea due to the epidemic strain of C. difficile, as compared with patients whose diarrhea was due to nonepidemic strains (pooled odds ratio, 4.35; 95 percent confidence interval, 2.02 to 9.38; P<0.001). Exposure to other types of antibiotics or hospitalization in a surgical ward was not significantly associated with the risk of C. difficile-associated diarrhea due to the epidemic strain. All epidemic-strain isolates were highly resistant to clindamycin (minimal inhibitory concentration, >256 microg per milliliter). DNA hybridization and PCR analysis showed that all these isolates had an ermB gene, which encodes a 23S ribosomal RNA methylase that mediates resistance to macrolide, lincosamide, and streptogramin antibiotics. Only 15 percent of the nonepidemic strains were resistant to clindamycin.
Conclusions: A strain of C. difficile that is highly resistant to clindamycin was responsible for large outbreaks of diarrhea in four hospitals in different states. The use of clindamycin is a specific risk factor for diarrhea due to this strain. Resistance to clindamycin further increases the risk of C. difficile-associated diarrhea, an established complication of antimicrobial use.
Similar articles
- Control of an outbreak of diarrhoea in a vascular surgery unit caused by a high-level clindamycin-resistant Clostridium difficile PCR ribotype 106.
Ratnayake L, McEwen J, Henderson N, Nathwani D, Phillips G, Brown D, Coia J. Ratnayake L, et al. J Hosp Infect. 2011 Nov;79(3):242-7. doi: 10.1016/j.jhin.2011.06.013. Epub 2011 Aug 23. J Hosp Infect. 2011. PMID: 21864938 - [Epidemiological study of Clostridium difficile strains isolated in Jean-Verdier-René-Muret hospitals from 2001 to 2007].
Poilane I, Fantinato C, Cruaud P, Collignon A. Poilane I, et al. Pathol Biol (Paris). 2008 Nov-Dec;56(7-8):412-6. doi: 10.1016/j.patbio.2008.07.009. Epub 2008 Oct 7. Pathol Biol (Paris). 2008. PMID: 18842360 French. - [Epidemiology of Clostridium difficile infection].
Szczesny A, Martirosian G. Szczesny A, et al. Przegl Epidemiol. 2002;56(1):49-56. Przegl Epidemiol. 2002. PMID: 12150067 Review. Polish. - The growing incidence and severity of Clostridium difficile infection in inpatient and outpatient settings.
Khanna S, Pardi DS. Khanna S, et al. Expert Rev Gastroenterol Hepatol. 2010 Aug;4(4):409-16. doi: 10.1586/egh.10.48. Expert Rev Gastroenterol Hepatol. 2010. PMID: 20678014 Review.
Cited by
- Beyond Antibiotics: Novel Approaches in the Treatment of Recurrent Clostridioides difficile Infection.
Zaidi SMH, Haider R, Kazmi SAB, Husnain A, Khan S, Merchant S, Tayyab H, Wazeen FR, Chaudhary AJ. Zaidi SMH, et al. ACG Case Rep J. 2024 Jul 27;11(8):e01333. doi: 10.14309/crj.0000000000001333. eCollection 2024 Aug. ACG Case Rep J. 2024. PMID: 39081300 Free PMC article. No abstract available. - Clinical Characteristics and Risk Factors for Clostridioides difficile Infection in the Hematopoietic Cell Transplantation Population.
Deshpande A, O'Brien J, Hamilton B, Pappas M. Deshpande A, et al. Res Sq [Preprint]. 2024 Jul 10:rs.3.rs-4531064. doi: 10.21203/rs.3.rs-4531064/v1. Res Sq. 2024. PMID: 39041031 Free PMC article. Preprint. - Toxin genotypes, antibiotic resistance and their correlations in Clostridioides difficile isolated from hospitals in Xi'an, China.
Zhang S, Ma C, Zhang H, Zhao C, Guo R, Liu J, Wang J, Yuan J, Jia K, Wu A, Chen Y, Lei J. Zhang S, et al. BMC Microbiol. 2024 May 23;24(1):177. doi: 10.1186/s12866-024-03327-z. BMC Microbiol. 2024. PMID: 38783194 Free PMC article. - Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options.
Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Di Bella S, et al. Clin Microbiol Rev. 2024 Jun 13;37(2):e0013523. doi: 10.1128/cmr.00135-23. Epub 2024 Feb 29. Clin Microbiol Rev. 2024. PMID: 38421181 Review. - The combined effect of systemic antibiotics and proton pump inhibitors on Clostridioides difficile infection and recurrence.
Moreels N, Boven A, Gressani O, Andersson FL, Vlieghe E, Callens S, Engstrand L, Simin J, Brusselaers N. Moreels N, et al. J Antimicrob Chemother. 2024 Mar 1;79(3):608-616. doi: 10.1093/jac/dkae012. J Antimicrob Chemother. 2024. PMID: 38267263 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical