ABSTRACT
A clindamycin-resistant toxin A-negative, toxin B-positive Clostridium difficile strain caused an outbreak among 24 hospitalized patients at the Department of Surgery, the Intensive Care unit, and the Department of Internal Medicine of an 800-bed academic hospital. Nineteen patients had undergone a surgical intervention and all 24 patients received at least one dose of antibiotics prior to the development of Clostridium difficile-associated diarrhoea. Twenty-seven episodes of Clostridium difficile-associated diarrhoea in 24 patients were categorized as mild (n=19), severe (n=7), or fatal (n=1). Relapses occurred in three patients. Nineteen of the 27 episodes required anti-Clostridium difficile treatment. Molecular typing performed by arbitrary primer polymerase chain reaction (PCR) and PCR amplification of rRNA intergenic spacer regions revealed that the outbreak strains recovered from culture were identical. The outbreak strain belonged to serogroup F and was resistant to erythromycin, clindamycin, and tetracycline, whereas susceptibility to chloramphenicol varied. No phenotypic activity of enterotoxin A was detected. A deletion of approximately 1.7 kb was found in the toxin A gene. Cytotoxin B had an unusual effect on cell culture assays that, at first, was not recognized as Clostridium difficile specific but could be neutralized with anti-Clostridium difficile B cytotoxin.
Subject(s)
Bacterial Proteins , Clostridioides difficile/drug effects , Cross Infection/epidemiology , Diarrhea/epidemiology , Disease Outbreaks , Enterocolitis, Pseudomembranous/epidemiology , Adult , Aged , Anti-Bacterial Agents/pharmacology , Bacterial Toxins/genetics , Bacterial Toxins/toxicity , Clindamycin/pharmacology , Clostridioides difficile/classification , Clostridioides difficile/genetics , Clostridioides difficile/isolation & purification , Cross Infection/microbiology , Diarrhea/microbiology , Drug Resistance, Bacterial , Enterocolitis, Pseudomembranous/microbiology , Enterotoxins/genetics , Female , Humans , Male , Middle Aged , Polymerase Chain Reaction , PrevalenceABSTRACT
Hickman catheters can be used to secure prolonged access to the venous system. We have retrospectively analysed the incidence of complications, risk factors for the occurrence of complications and patient satisfaction in 120 catheters. The total number of complications was 30, leading to the removal of 15 catheters. The majority of complications were infectious, occurring 28 times and leading to catheter removal in 13 patients. Other complications (i.e. catheter thrombosis) were rare. The only identifiable risk factor for the occurrence of complications was the male gender, associated with a higher rate of catheter infection. Patient satisfaction after catheter insertion, assessed by a questionnaire to which 24 of the 30 patients responded, was high. This report indicates that the use of Hickman catheters is associated with an acceptable complication rate and a high level of patient satisfaction.
