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Nosocomial acquisition of Clostridium difficile infection
American
52
Reviews
consumed more often by patients (2 1%) than by age-matched control subjects (4%) in the week before onset of illness. Two patients and no control subjects had drunk cow’s milk. Fourteen patients (58%) required hospitalization for an average duration of 3.4 days. This study represents the first prospective, population-based study that has identified E. coli 0157:H7 as a cause of sporadic diarrhea in the United States. The results suggest that the incidence of medically detected enteric E. coli 0157:H7 infection was lower than that for Carnpylobacter or Salmonella but slightly higher than that for Shigella. This confirms the finding on outbreak investigations that ground beef and raw milk can serve as vehicles for transmitting infection. Infection with E. coli 0157:H7 should be included in the differential diagnosis of patients with bloody diarrhea. Clinicians should be encouraged to consider screening for this pathogen in their workups for patients with this condition. If this pathogen is identified, these cases should be reported to local or state health departments to help detect clusters of productassociated infection and to institute appropriate infection control measures. Nosocomial acquisition of Closfridium difficile infection McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. N Engl J Med 1989;320:204-10. Reprint requests: Lynn V. McFarland, MD, Department of Medicine, ZA-89, Harborview Medical Center, Seattle, WA 98104. Investigators at the University of Washington studied the acquisition and transmission of Clostridium dificile infection prospectively on a general medical ward. They collected rectalswab specimens at the time of admission and every 3 days from 428 patients hospitalized during an 1 l-month period. Immunoblot typing was used to differentiate individual strains of C. dificile. The cultures of 29 patients (7%) were positive at the time of admission; 83 of the 399 patients with negative cultures (21%) acquired C. difficile during their hospitalizations. Of these, 52 (63%) remained asymptomatic and 31 (37%) had diarrhea; none had colitis. Patient-to-
INFECTION
Journal
of
CONTROL
patient transmission was evidenced by timespace clustering of incident cases with identical immunoblot types and by significantly more frequent and earlier acquisition of C. dificile among patients exposed to roommates’ positive cultures. Of the hospital personnel who cared for patients with positive cultures, 59% (20) had positive cultures for C. dificiZe from their hands. Contamination was identified in 49% of the hospital rooms occupied by symptomatic patients and 29% of the rooms occupied by asymptomatic patients. Eighty-two percent of the infected cohort still had positive cultures at their time of discharge; these patients were significantly more likely to be discharged to a long-term care facility. The investigators concluded that nosocomial C. dificile infection was frequently transmitted among hospitalized patients and that the organism was often present in their immediate environment and on the hands of hospital personnel who cared for these patients. Infection control practitioners should be aware of the high likelihood for nosocomial transmission of C. di#iciZe organism in patients with identified infections. High rates of infection, colonization, and environmental contamination associated with asymptomatic cases emphasize the need for universal blood and body fluid precautions to limit the spread of this nosocomial pathogen more effectively.
Association of influenza immunization reduction in mortality in an elderly population. A prospective study
with
Gross PA, Quinnan GV, Rodstein M, et al. Arch Intern Med 1988;148:582-5. Reprint requests: Peter A. Gross, MD, Department of Internal Medicine, Hackensack Medical Center, 30 Prospect St., Hackensack, NJ 07801.
Prior studies have suggested that elderly persons and those with chronic diseases are most prone to serious complications from influenza virus infection. Most of these studies, however, are retrospective and have not included laboratory confirmation of influenza infection. This study prospectively evaluated the efficacy of vaccine during an influenza A/Arizona/80 (H3N2) outbreak at the Jewish Home and Hos-
52
Reviews
consumed more often by patients (2 1%) than by age-matched control subjects (4%) in the week before onset of illness. Two patients and no control subjects had drunk cow’s milk. Fourteen patients (58%) required hospitalization for an average duration of 3.4 days. This study represents the first prospective, population-based study that has identified E. coli 0157:H7 as a cause of sporadic diarrhea in the United States. The results suggest that the incidence of medically detected enteric E. coli 0157:H7 infection was lower than that for Carnpylobacter or Salmonella but slightly higher than that for Shigella. This confirms the finding on outbreak investigations that ground beef and raw milk can serve as vehicles for transmitting infection. Infection with E. coli 0157:H7 should be included in the differential diagnosis of patients with bloody diarrhea. Clinicians should be encouraged to consider screening for this pathogen in their workups for patients with this condition. If this pathogen is identified, these cases should be reported to local or state health departments to help detect clusters of productassociated infection and to institute appropriate infection control measures. Nosocomial acquisition of Closfridium difficile infection McFarland LV, Mulligan ME, Kwok RYY, Stamm WE. N Engl J Med 1989;320:204-10. Reprint requests: Lynn V. McFarland, MD, Department of Medicine, ZA-89, Harborview Medical Center, Seattle, WA 98104. Investigators at the University of Washington studied the acquisition and transmission of Clostridium dificile infection prospectively on a general medical ward. They collected rectalswab specimens at the time of admission and every 3 days from 428 patients hospitalized during an 1 l-month period. Immunoblot typing was used to differentiate individual strains of C. dificile. The cultures of 29 patients (7%) were positive at the time of admission; 83 of the 399 patients with negative cultures (21%) acquired C. difficile during their hospitalizations. Of these, 52 (63%) remained asymptomatic and 31 (37%) had diarrhea; none had colitis. Patient-to-
INFECTION
Journal
of
CONTROL
patient transmission was evidenced by timespace clustering of incident cases with identical immunoblot types and by significantly more frequent and earlier acquisition of C. dificile among patients exposed to roommates’ positive cultures. Of the hospital personnel who cared for patients with positive cultures, 59% (20) had positive cultures for C. dificiZe from their hands. Contamination was identified in 49% of the hospital rooms occupied by symptomatic patients and 29% of the rooms occupied by asymptomatic patients. Eighty-two percent of the infected cohort still had positive cultures at their time of discharge; these patients were significantly more likely to be discharged to a long-term care facility. The investigators concluded that nosocomial C. dificile infection was frequently transmitted among hospitalized patients and that the organism was often present in their immediate environment and on the hands of hospital personnel who cared for these patients. Infection control practitioners should be aware of the high likelihood for nosocomial transmission of C. di#iciZe organism in patients with identified infections. High rates of infection, colonization, and environmental contamination associated with asymptomatic cases emphasize the need for universal blood and body fluid precautions to limit the spread of this nosocomial pathogen more effectively.
Association of influenza immunization reduction in mortality in an elderly population. A prospective study
with
Gross PA, Quinnan GV, Rodstein M, et al. Arch Intern Med 1988;148:582-5. Reprint requests: Peter A. Gross, MD, Department of Internal Medicine, Hackensack Medical Center, 30 Prospect St., Hackensack, NJ 07801.
Prior studies have suggested that elderly persons and those with chronic diseases are most prone to serious complications from influenza virus infection. Most of these studies, however, are retrospective and have not included laboratory confirmation of influenza infection. This study prospectively evaluated the efficacy of vaccine during an influenza A/Arizona/80 (H3N2) outbreak at the Jewish Home and Hos-