Toxin-producing Clostridium difficile is the commonest bacterial cause of nosocomial diarrhoea and is a well recognized cause of hospital outbreaks in elderly care units.
High C. difficile disease rates have been associated with the use of broad-spectrum antibiotics, especially cephalosporins.
An outbreak of C. difficile infection in the elderly care unit at Gloucestershire Royal NHS Trust continued despite increased ward cleaning and strict implementation of infection control measures.
A restrictive antibiotic policy that would maintain colonization resistance in the gastrointestinal tract was introduced throughout this unit.
Patients admitted with suspected infection were prescribed intravenous (iv) benzyl-penicillin 1.2-1.8 g every 6 h to cover streptococcal infections and iv trimethoprim 200 mg twice daily to cover urinary tract pathogens and Haemophilus influenzae.
If the patient had septic shock a single iv dose of gentamicin was given (120-180 mg) to cover more resistant Gram-negative bacilli.
The following were monitored before and after the policy change.
The number of cases of C. difficile toxin-positive diarrhoea ; cefuroxime and total antibiotic use on the elderly care wards ; patient mortality rates ; and length of hospital stay :
The number of cases of C. difficile toxin-positive diarrhoea ;
cefuroxime and total antibiotic use on the elderly care wards ;
patient mortality rates ;
two hundred and fifty-two and 234 patients respectively with a discharge diagnosis of infection were admitted before and after the antibiotic policy change.
Mortality rates and length of hospital stay were unchanged. (...)
Mots-clés Pascal : Antibiotique, Céphalosporine dérivé, Clostridium difficile, Clostridiaceae, Clostridiales, Bactérie, Infection, Vieillard, Homme, Diarrhée, Hôpital, Traitement, Mortalité, Pénicilline dérivé, Activité biologique, Antibactérien, Politique sanitaire, Appareil digestif pathologie, Intestin pathologie
Mots-clés Pascal anglais : Antibiotic, Cephalosporin derivatives, Clostridium difficile, Clostridiaceae, Clostridiales, Bacteria, Infection, Elderly, Human, Diarrhea, Hospital, Treatment, Mortality, Penicillin derivatives, Biological activity, Antibacterial agent, Health policy, Digestive diseases, Intestinal disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0049549
Code Inist : 002B02S02. Création : 14/05/1998.