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Clostridium difficile Disease in a Department of Surgery: The Significance of Prophylactic Antibiotics

Clostridium difficile Disease in a Department of Surgery: The Significance of Prophylactic... Abstract • A clustering of Clostridium difficile–associated disease in a department of surgery prompted a program of infection control and the evaluation of contributing factors. Fifty patients had diarrhea and positive assays for C difficile cytotoxin during the study period. Twenty-one of the 36 cases that developed among patients admitted to the surgical services occurred on two adjacent general surgery wards that shared attending surgeons and house staff. Perioperative prophylactic antibiotics predated C difficile–associated disease in 20 patients, 12 of whom had short courses (24 hours). Symptoms were typically nonspecific and early diagnosis may be difficult. Incidence remained high, despite infection control measures, until the coincidental closure of two surgical wards. Clostridium difficile–associated disease is a nosocomial infection that can be associated with short courses of prophylactic antibiotics. Recommendations regarding the use of perioperative prophylaxis should recognize C difficile–associated disease as a significant potential complication. (Arch Surg. 1991;126:241-246) References 1. Tedesco FJ, Barton RW, Alpers HD. Clindamycin-associated colitis: a prospective study . Ann Intern Med . 1974;81:429-433.Crossref 2. Fekety R, Kim K-H, Brown D, Batts DH, Cudmore M, Silva J. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment . Am J Med . 1981;70:906-908.Crossref 3. Pierce PF, Wilson R, Silva J, et al. Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases . J Infect Dis . 1982;145:269-274.Crossref 4. Gerding DN, Olson MM, Peterson LR, et al. Clostridium difficile–associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study . Arch Intern Med . 1986;146:95-100.Crossref 5. Bender BS, Laughon BE, Gaydos C, et al. Is Clostridium difficile endemic in chronic-care facilities? Lancet . 1986;2:11-13.Crossref 6. Foulke GE, Silva J. Clostridium difficile in the intensive care unit: management problems and prevention issues . Crit Care Med . 1989;17:822-826.Crossref 7. Evans M, Pollock AV. Trials on trial: a review of trials of antibiotic prophylaxis . Arch Surg . 1984;119:109-113.Crossref 8. Guglielmo BJ, Hohn DC, Koo PJ, Hunt TK, Sweet RL, Conte JE. Antibiotic prophylaxis in surgical procedures: a critical analysis of the literature . Arch Surg . 1983;118:943-955.Crossref 9. Platt R, Zalenznik DF, Hopkins CC, et al. Perioperative antibiotic prophylaxis for herniorraphy and breast surgery . N Engl J Med . 1990; 322:153-160.Crossref 10. Bartlett JG, Chang RW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia . N Engl J Med . 1978;298:531-534.Crossref 11. Lynch P, Jackson MM, Cummings MJ, Stamm WE. Rethinking the role of isolation practices in the prevention of nosocomial infections . Ann Intern Med . 1987;107:243-246.Crossref 12. Green RH. The association of viral activation with penicillin toxicity in guinea pigs and hamsters . Yale J Biol Med . 1974;47:166-181. 13. Larson HE, Parry JV, Price AB, Davies DR, Dolby J, Tyrrell DAJ. Undescribed toxin in pseudomembranous colitis . BMJ . 1977;1:1246-1248.Crossref 14. Moskovitz M, Bartlett JG. Recurrent pseudomembranous colitis unassociated with prior antibiotic therapy . Arch Intern Med . 1981;141:663-664.Crossref 15. Bartlett JG. Clostridium difficile: clinical considerations . Rev Infect Dis . 1990;12( (suppl 2) ):243-251.Crossref 16. Aronsson B, Mollby R, Nord C-E. Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980-1982 . J Infect Dis . 1985;151:472-481.Crossref 17. Viscidi R, Willey S, Bartlett JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations . Gastroenterology . 1981;81:5-9. 18. McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection . N Engl J Med . 1989;320:204-210.Crossref 19. Heard SR, O'Farrell S, Holland D, Crook S, Barnett MJ, Tabaqchali S. The epidemiology of Clostridium difficile with the use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients . J Infect Dis . 1986;153:159-162.Crossref 20. Tabaqchali S, O'Farrell S, Holland D, Stilman R. Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies . Lancet . 1984;1:935-928.Crossref 21. Talbot RW, Walker RC, Beart RW. Changing epidemiology, diagnosis, and treatment of Clostridium difficile toxin-associated colitis . Br J Surg . 1986;73:457-460.Crossref 22. Mogg GAG, Keighley MRB, Burdon DW, et al. Antibiotic-associated colitis: a review of 66 cases . Br J Surg . 1979;66:738-742.Crossref 23. Gerding DN, Olson MM, Johnson S, Peterson LT, Lee JT. Clostridium difficile diarrhea and colonization regimens containing clindamycin or metronidazole . Am J Surg . 1990;159:212-217.Crossref 24. Drapkin MS, Worthington MG, Chang T-W, Razvi SA. Clostridium difficile colitis mimicking acute peritonitis . Arch Surg . 1985;120:1321-1332.Crossref 25. Tedesco FJ. Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination . Gastroenterology . 1979;77:295-298. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Clostridium difficile Disease in a Department of Surgery: The Significance of Prophylactic Antibiotics

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410260131019
Publisher site
See Article on Publisher Site

Abstract

Abstract • A clustering of Clostridium difficile–associated disease in a department of surgery prompted a program of infection control and the evaluation of contributing factors. Fifty patients had diarrhea and positive assays for C difficile cytotoxin during the study period. Twenty-one of the 36 cases that developed among patients admitted to the surgical services occurred on two adjacent general surgery wards that shared attending surgeons and house staff. Perioperative prophylactic antibiotics predated C difficile–associated disease in 20 patients, 12 of whom had short courses (24 hours). Symptoms were typically nonspecific and early diagnosis may be difficult. Incidence remained high, despite infection control measures, until the coincidental closure of two surgical wards. Clostridium difficile–associated disease is a nosocomial infection that can be associated with short courses of prophylactic antibiotics. Recommendations regarding the use of perioperative prophylaxis should recognize C difficile–associated disease as a significant potential complication. (Arch Surg. 1991;126:241-246) References 1. Tedesco FJ, Barton RW, Alpers HD. Clindamycin-associated colitis: a prospective study . Ann Intern Med . 1974;81:429-433.Crossref 2. Fekety R, Kim K-H, Brown D, Batts DH, Cudmore M, Silva J. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment . Am J Med . 1981;70:906-908.Crossref 3. Pierce PF, Wilson R, Silva J, et al. Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases . J Infect Dis . 1982;145:269-274.Crossref 4. Gerding DN, Olson MM, Peterson LR, et al. Clostridium difficile–associated diarrhea and colitis in adults: a prospective case-controlled epidemiologic study . Arch Intern Med . 1986;146:95-100.Crossref 5. Bender BS, Laughon BE, Gaydos C, et al. Is Clostridium difficile endemic in chronic-care facilities? Lancet . 1986;2:11-13.Crossref 6. Foulke GE, Silva J. Clostridium difficile in the intensive care unit: management problems and prevention issues . Crit Care Med . 1989;17:822-826.Crossref 7. Evans M, Pollock AV. Trials on trial: a review of trials of antibiotic prophylaxis . Arch Surg . 1984;119:109-113.Crossref 8. Guglielmo BJ, Hohn DC, Koo PJ, Hunt TK, Sweet RL, Conte JE. Antibiotic prophylaxis in surgical procedures: a critical analysis of the literature . Arch Surg . 1983;118:943-955.Crossref 9. Platt R, Zalenznik DF, Hopkins CC, et al. Perioperative antibiotic prophylaxis for herniorraphy and breast surgery . N Engl J Med . 1990; 322:153-160.Crossref 10. Bartlett JG, Chang RW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia . N Engl J Med . 1978;298:531-534.Crossref 11. Lynch P, Jackson MM, Cummings MJ, Stamm WE. Rethinking the role of isolation practices in the prevention of nosocomial infections . Ann Intern Med . 1987;107:243-246.Crossref 12. Green RH. The association of viral activation with penicillin toxicity in guinea pigs and hamsters . Yale J Biol Med . 1974;47:166-181. 13. Larson HE, Parry JV, Price AB, Davies DR, Dolby J, Tyrrell DAJ. Undescribed toxin in pseudomembranous colitis . BMJ . 1977;1:1246-1248.Crossref 14. Moskovitz M, Bartlett JG. Recurrent pseudomembranous colitis unassociated with prior antibiotic therapy . Arch Intern Med . 1981;141:663-664.Crossref 15. Bartlett JG. Clostridium difficile: clinical considerations . Rev Infect Dis . 1990;12( (suppl 2) ):243-251.Crossref 16. Aronsson B, Mollby R, Nord C-E. Antimicrobial agents and Clostridium difficile in acute enteric disease: epidemiological data from Sweden, 1980-1982 . J Infect Dis . 1985;151:472-481.Crossref 17. Viscidi R, Willey S, Bartlett JG. Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations . Gastroenterology . 1981;81:5-9. 18. McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection . N Engl J Med . 1989;320:204-210.Crossref 19. Heard SR, O'Farrell S, Holland D, Crook S, Barnett MJ, Tabaqchali S. The epidemiology of Clostridium difficile with the use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients . J Infect Dis . 1986;153:159-162.Crossref 20. Tabaqchali S, O'Farrell S, Holland D, Stilman R. Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies . Lancet . 1984;1:935-928.Crossref 21. Talbot RW, Walker RC, Beart RW. Changing epidemiology, diagnosis, and treatment of Clostridium difficile toxin-associated colitis . Br J Surg . 1986;73:457-460.Crossref 22. Mogg GAG, Keighley MRB, Burdon DW, et al. Antibiotic-associated colitis: a review of 66 cases . Br J Surg . 1979;66:738-742.Crossref 23. Gerding DN, Olson MM, Johnson S, Peterson LT, Lee JT. Clostridium difficile diarrhea and colonization regimens containing clindamycin or metronidazole . Am J Surg . 1990;159:212-217.Crossref 24. Drapkin MS, Worthington MG, Chang T-W, Razvi SA. Clostridium difficile colitis mimicking acute peritonitis . Arch Surg . 1985;120:1321-1332.Crossref 25. Tedesco FJ. Antibiotic associated pseudomembranous colitis with negative proctosigmoidoscopy examination . Gastroenterology . 1979;77:295-298.

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1991

References