Severe Clostridium difficile – Associated Disease in Populations Previously at Low Risk – Four States, 2005 | National Resource for Infection Control (NRIC)

Severe Clostridium difficile – Associated Disease in Populations Previously at Low Risk – Four States, 2005

Case report, Outbreak report
Abstract: 
This report summarizes the results of an investigation in Pennsylvania and three other states following the reporting of several cases of serious CDAD in otherwise healthy patients with minimal or no exposure to healthcare settings. The presence of severe CDAD in healthy persons living in the community and peripartum women, two populations previously thought to be at low risk underscore the importance of prudent antimicrobial use, the need for community clinicians to maintain a higher index of suspicion for CDAD and the need for surveillance to better understand the changing epidemiology of CDAD
Authors: 
Reported by E ChernakMDCC JohnsonMDPhiladelphia Dept of Public HealthA WeltmanMDPennsylvania Dept of Health. LC McDonaldMDL WiggsG KillgoreDrPHA ThompsonMSScDiv of Healthcare Quality PromotionNational Center for Infectious DiseasesM LeMaile-WilliamsMDE TanMBBSFM LewisMDEIS officersCDC.
Category: 
Clinical description
Control
Epidemiology
Management
Prevention

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Summary:
This report summarizes the results of an investigation in Pennsylvania and three other states following the reporting of several cases of serious CDAD in otherwise healthy patients with minimal or no exposure to healthcare settings. The presence of severe CDAD in healthy persons living in the community and peripartum women, two populations previously thought to be at low risk underscore the importance of prudent antimicrobial use, the need for community clinicians to maintain a higher index of suspicion for CDAD and the need for surveillance to better understand the changing epidemiology of CDAD
Questions Addressed:
This report summarizes the results of an investigation in Pennsylvania and three other states following the reporting of several cases of serious CDAD in otherwise healthy patients with minimal or no exposure to healthcare settings.
Type of Study:
Outbreak report, Case report
Methods Valid:
Yes
Methods Valid Detail:
Results Reliability:
Yes as far as the cases investigated are concerned
Problems or Biases:

Report subject to some limitations: - · Report describes a convenience sample so results subject to reporting and selection biases · Sample collected in limited geographic region therefore results might not be generalizable to other regions · Single national estimate for ambulatory prescribing rates was applied to this region, substantial variation in these rates might exist

Relevant Studies:

1. Clostridium Difficile Infection – Prevention and management. A Report by a Department of health/Public health Laboratory Service Joint Working Group (1994) 2. National Clostridium difficile Standards Group Report to the Department of health. The Journal of Hospital Infection (2004)56; 1-38 (Supplement 1) http://intl.elsevierhealth.com/journals/jhin/Default.cfmAlso available from the Health protection Agency Website http://www.hpa.org.uk/infections/topics_az/clostridium_difficile/FINALCd... 3. Department of Health. A simple guide to Clostridium difficile (19th July 2005) http://www.dh.gov.uk/PublicationsAndStatistics/Publications/Publications...

Keywords:
Clostridium difficile Clostridium difficile associated diarrhoea (CDAD) antibiotic prescribing surveillance
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association