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.”