Starr J M, Rogers T R, Impallomeni M
Department of Geriatric Medicine, University of Edinburgh, Royal Victoria Hospital, UK.
Lancet. 1997 Feb 8;349(9049):426-8. doi: 10.1016/S0140-6736(97)80053-0.
Clostridium difficile diarrhoea represents a significant health-service burden. We recently experienced an outbreak of C difficile diarrhoea associated with increased use of cefotaxime. The question we pose in this paper is how did the introduction and withdrawal of a single antibiotic so greatly affect rates of C difficile diarrhoea? Other antibiotics had nearly as high a risk of causing diarrhoea as cefotaxime, and the majority of patients never received cefotaxime. We believe that such outbreaks of C difficile diarrhoea are best understood in terms of a population model, and that taking antibiotics like cefotaxime should be thought of as a population rather than an individual risk factor. We postulate a herd-immunity model of C difficile diarrhoea, and examine the implications of this hypothesis.
