| Title |
An outbreak of Clostridium difficile PCR ribotype 027 in Spain: risk factors for recurrence and a novel treatment strategy
|
|---|---|
| Published in |
European Journal of Clinical Microbiology & Infectious Diseases, May 2017
|
| DOI | 10.1007/s10096-017-2991-y |
| Pubmed ID | |
| Authors |
E. Bouza, L. Alcalá, M. Marín, M. Valerio, E. Reigadas, P. Muñoz, M. González-Del Vecchio, V. de Egea |
| Abstract |
An outbreak of Clostridium difficile infection (CDI) caused by ribotype 027 (B1/NAP1) began in our hospital in November 2014, and produced 141 episodes in the following months. The aim of this study is to describe this outbreak, assess risk factors for recurrence of CDI-027 and to analyze the implementation of a novel treatment strategy. This is a prospective study of all patients with CDI-027, from November 2014 to November 2015. The epidemiological data were collected daily for each patient. We compared clinical characteristics and treatment between patients with and without recurrence of CDI-027. Interestingly, liver cirrhosis was present in 22% of the patients, and most of them received prophylaxis for hepatic encephalopathy with rifaximin. Patients were also taking antimicrobial drugs (93.6%) and proton pump inhibitors (80.1%). Overall, 27 (23.5%) patients had a first recurrence of CDI-027. Liver cirrhosis increased the risk of recurrence (44.4% vs 14.8%). Patients treated with a prolonged oral vancomycin regimen vs the conventional regimen (oral metronidazole or 10 days of vancomycin) had fewer recurrences (8.6 versus 44.7% [p ≤ 0.01]; OR, 0.91; 95% CI, 0.028-0.294) and less attributable mortality (0% versus 7.1%; p = 0.058). We report an outbreak of CDI-027, mainly in patients with liver cirrhosis. Recurrence of CDI-027 was more common in those patients. A novel approach involving high-dose prolonged vancomycin taper as a first-line treatment, together with a bundle of outbreak measures, seemed to reduce the number of cases of CDI-027, recurrences, and attributable mortality. Nevertheless, this approach warrants further investigation. |
X Demographics
The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 50 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 50 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 10 | 20% |
| Student > Bachelor | 6 | 12% |
| Other | 5 | 10% |
| Student > Doctoral Student | 5 | 10% |
| Student > Master | 4 | 8% |
| Other | 11 | 22% |
| Unknown | 9 | 18% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 19 | 38% |
| Pharmacology, Toxicology and Pharmaceutical Science | 5 | 10% |
| Biochemistry, Genetics and Molecular Biology | 3 | 6% |
| Nursing and Health Professions | 3 | 6% |
| Veterinary Science and Veterinary Medicine | 1 | 2% |
| Other | 6 | 12% |
| Unknown | 13 | 26% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 June 2017.
All research outputs
#18,555,330
of 22,981,247 outputs
Outputs from European Journal of Clinical Microbiology & Infectious Diseases
#2,185
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Outputs of similar age
#236,057
of 309,521 outputs
Outputs of similar age from European Journal of Clinical Microbiology & Infectious Diseases
#40
of 58 outputs
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