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CLINICALLY-ACQUIREDDIARRHEA

CAUSED BY CLOSTRIDIUM

DIFFICILE

Kanita Dedic

General Hospital Bihac, Bosnia and Herzegovina

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Clostridium difficile

G+ spore forming

anaerobic rod

In soil, water,

intestines

An important

nosocomial

pathogen CDI-toxin producing

Clostridium difficile

Bauer,M.P.,Kujper,E.J.,Van Dissel,J.T.(2009).ESCMID:Treatment guidance forCDI

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Risk factors

Exposure to toxigenic strain of C.difficile

Alteration normal enteric flora

Longer hospital stay

Use of antibiotics, esp. with broad spectrum

Increasing age

Underlying severe illness

Poutanen, S.M.,Simor,A.E.(2004)CMAJ:Clostridium difficile-associated diarrhea in adults

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C. difficile

Reservoir

Environment

Agent: C.difficile

Way of transmissionSpores on contaminated

hands, equipment or in the

environment

Route of transmissionFaecal-oral

Sensible host

Infection chain

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Between November 2011 and may 2012

increased number of severe diarrhea among

the patients in several clinics in KCUS was

observed

Stool samples analysis was done with EIA test

Serazym C. difficile toxin A+B(Seramun)

50 stool samples were positive

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Aim of study

Examine the main risk factors for outbreak of

clostridium difficile associated diarrhea

Examine relation between antibiotic therapy

which patients were taking, length of therapy

and patients age

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All the cases are spatially and temporally

related =intra-hospital C.difficile

epidemic

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Over65

Below 65

Age

Over

50

Below 50

Age

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Risk factors

Exposure to toxigenic strain of C.difficile =

toxin A/B positive

Alteration of normal enteric flora = antibiotics

(long therapy 2-42 days)

Use of antibiotics, esp. with broad spectrum =

ceftriaxon, cefazolin+multiply ab Increasing age = over 50

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Infection chain

1stpositive patient was from Clinic for Urology

1stsymptoms started 12th day of antibiotic

therapy by ceftriaxon

After this patient, 8 patients in the same clinic

with similar symptoms- test positive

Spread of the infection to another clinics

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What was done

Team for prevention and control ofintrahospital infection prepared protocol for C.difficile infections

Special attention given to:1. washing hands properly

2. limiting the use of antibiotics

3. using intrahospital precaution measures forpatients with diarrhea

4. cleaning the environment and the equipmentmeticulously

Worsley,M.A.,(1998).Infection control and prevention of

Clostridium difficile infection.JAC 41,Suppl.C,59-66

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Thank you for your attention!