Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica

Roy A Wong-McClure; Elenita Ramírez-Salas; Nury Mora-Brenes; Lorena Aguero-Sandí; Maritza Morera-Sigler; Xiomara Badilla-Vargas; Marcela Hernández-de Merzerville; Michele O’Shea; Elizabeth Bryce

doi:10.3855/jidc.2854

Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica

Authors

Roy A Wong-McClure Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica
Elenita Ramírez-Salas Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica
Nury Mora-Brenes Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San José, Costa Rica
Lorena Aguero-Sandí Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica
Maritza Morera-Sigler Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica
Xiomara Badilla-Vargas Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica
Marcela Hernández-de Merzerville Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, Caja Costarricense de Seguro Social, San José, Costa Rica
Michele O’Shea University of Arizona College of Medicine, Phoenix, Arizona, United States
Elizabeth Bryce Vancouver General Hospital, Vancouver, British Columbia, Canada

DOI:

https://doi.org/10.3855/jidc.2854

Keywords:

Clostridium difficile, enterocolitis, infection control, infectious disease outbreaks

Abstract

Introduction: The C. difficile BI/NAP 1 hyper virulent strain has been responsible for the nosocomial outbreaks in several countries. The present study describes the infection control strategies utilized to achieve outbreak control as well as the factors associated with a C. difficile BI/NAP 1 hyper virulent strain outbreak in Costa Rica.

Methodology: A descriptive analysis of the C. difficile outbreak was completed for the period of January 2007 to December 2010 in one affected hospital. An unmatched case-control study was subsequently performed to evaluate the association of exposure factors with C. difficile infection.

Results: The pattern of the outbreak was characterized by a sharp increase in the incidence rate during the initial weeks of the outbreak, which was followed by a reduction in the incidence curve as several infection control measures were implemented.

The C. difficile BI/NAP1 infection was associated with the prescription of antibiotics, in particular levofloxacin (OR: 9.3; 95%CI: 2.1-40.2), meropenem (OR: 4.9, 95%CI: 1.0-22.9), cefotaxime (OR: 4.3, 95%CI: 2.4-7.7), as well as a medical history of diabetes mellitus (OR: 2.9, 95%CI: 1.5-5.8).

Conclusions: The infection control strategies implemented proved to be effective in achieving outbreak control and in maintaining the baseline C. difficile incidence rate following it. The reported C. difficile outbreak was associated with the prescription of broad-spectrum antibiotics and a medical history of diabetes.

Author Biography

Roy A Wong-McClure, Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, Genaro Valverde Building, Second Avenue, San José, Costa Rica

Professor in Epidemiology Universidad Latina de Costa Rica

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Published

2013-12-15

How to Cite

Wong-McClure RA, Ramírez-Salas E, Mora-Brenes N, Aguero-Sandí L, Morera-Sigler M, Badilla-Vargas X, Hernández-de Merzerville M, O’Shea M, Bryce E (2013) Long term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica. J Infect Dev Ctries 7:914–921. doi: 10.3855/jidc.2854

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Issue

Vol. 7 No. 12: December 2013

Section

Outbreak

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