Ninewells Hospital, NHS Tayside, Dundee, UK.
J Hosp Infect. 2011 Nov;79(3):242-7. doi: 10.1016/j.jhin.2011.06.013. Epub 2011 Aug 23.
This report describes an outbreak of Clostridium difficile infection (CDI) in a vascular surgery ward in 2009 caused by a high-level clindamycin-resistant ribotype 106. A case of CDI was defined as a patient with diarrhoea, positive for C. difficile toxin and negative for other enteric pathogens. Cultures were sent to the Scottish Salmonella Shigella and Clostridium difficile Reference Laboratory (SSSCDRL) for PCR ribotyping, antibiotic susceptibility testing and PCR detection of ermB. The mean age of the nine patients was 73 years (range: 38-90 years). All had received clindamycin and ciprofloxacin. All cases were typed as PCR ribotype 106 and they showed high-level resistance to clindamycin. Five of these isolates were tested by PCR for the presence of the ermB gene and no amplification was detected. This strain has rarely been isolated from patients on this ward. The outbreak was controlled successfully by closure of the ward with terminal cleaning, reinforcement of infection control precautions and the introduction of a new antibiotic policy. It is notable that this outbreak was caused by a strain with high-level clindamycin resistance not mediated by ermB. It also re-emphasizes that outbreaks of CDI can be caused by C. difficile PCR ribotypes other than 027. The outbreak was most likely associated with the use of clindamycin and ciprofloxacin cross-infection with spores in this environment. Implementation of strict infection control precautions, antimicrobial stewardship and enhanced environmental cleaning are key components in managing such an outbreak successfully. The number of meticillin-resistant Staphylococcus aureus acquisitions also fell substantially after these interventions.
本报告描述了 2009 年血管外科病房爆发的艰难梭菌感染（CDI），由高水平克林霉素耐药的 106 型核糖体分型引起。CDI 病例定义为腹泻患者，艰难梭菌毒素阳性且其他肠道病原体阴性。将培养物送往苏格兰沙门氏菌志贺菌和艰难梭菌参考实验室（SSSCDRL）进行 PCR 核糖体分型、抗生素敏感性测试和 ermB 的 PCR 检测。9 名患者的平均年龄为 73 岁（范围：38-90 岁）。所有人都接受过克林霉素和环丙沙星治疗。所有病例均为 PCR 核糖体分型 106 型，对克林霉素表现出高水平耐药性。其中 5 株分离株通过 PCR 检测 ermB 基因的存在，未检测到扩增。这种菌株很少从该病房的患者中分离出来。通过关闭病房进行终末清洁、加强感染控制预防措施和引入新的抗生素政策，成功控制了疫情。值得注意的是，此次疫情是由高水平克林霉素耐药而不是 ermB 介导的菌株引起的。它还再次强调，CDI 爆发可能由 027 以外的其他艰难梭菌 PCR 核糖体分型引起。此次疫情很可能与环境中克林霉素和环丙沙星交叉感染的孢子有关。实施严格的感染控制预防措施、抗菌药物管理和加强环境清洁是成功管理此类疫情的关键组成部分。在采取这些干预措施后，耐甲氧西林金黄色葡萄球菌的数量也大幅下降。
