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News

Fluoroquinolones exposure a risk for C difficile diarrhea

This week's New England Journal of Medicine shows that a resistant strain of C difficile with a partial deletion of the tcdC gene causes diarrhea outbreak, and fluoroquinolones or cephalosporins exposure is a risk factor.

News image

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In 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficile-associated diarrhea.

In 2004, Dr Loo and colleagues from Canada conducted a prospective study at 12 Quebec hospitals.

The research team determined the incidence of nosocomial C difficile-associated diarrhea and its complications.

The team conducted a case-control study to identify risk factors for the disease.

Isolates of C difficile were typed by pulsed-field gel electrophoresis.

The isolates were analyzed for binary toxin genes and partial deletions in the toxin A and B repressor gene tcdC.

The team evaluated antimicrobial susceptibility in a subgroup of isolates.

A total of 1703 patients with 1719 episodes of nosocomial C difficile-associated diarrhea were identified.

A strain resistant to fluoroquinolones was found in 82% of isolates
New England Journal of Medicine

The researchers found that the incidence was 23 per 1000 admissions.

The 30-day attributable mortality rate was 7%.

The research team noted that case patients were more likely than matched controls to have received fluoroquinolones or cephalosporins.

A predominant strain, resistant to fluoroquinolones, was found in 82% of isolates.

In addition, the team observed that the binary toxin genes and partial deletions in the tcdC gene were present in 84% of isolates.

Dr Loo's team conclude, “A strain of C difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C difficile-associated diarrhea.”

“Exposure to fluoroquinolones or cephalosporins was a risk factor.”

NEJM 2005: 353(23): 2442-9
14 December 2005

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