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 Vol. 15 No. 2, February 2006
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AAP Grand Rounds 15:15-16 (2006)
© 2006 American Academy of Pediatrics

INFECTIOUS DISEASES

Clostridium difficile: Old Scourge Becomes Far Worse

Sources: (1) McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med. 2005;353:2433–2441.[Abstract/Free Full Text] (2) Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidty and mortality. N Engl J Med. 2005;353:2442–2449.[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.

Two recent multicenter studies in the New England Journal of Medicine, one each from the United States and Canada, report on the epidemic of Clostridium difficile. In the first report, researchers from the Centers for Disease Control and Prevention (CDC), Maine Medical Center–Portland, the University of Vermont–Burlington, and Hines Veterans Affairs Hospital and Loyola University, Hines, Ill evaluated C difficile isolates from patients in 8 health care facilities in 6 states that had outbreaks of C difficile-associated disease (CDAD) since 2001. CDAD includes a spectrum of gastrointestinal manifestations from diarrhea to a severe colitis characterized by the presence of a pseudomembrane and is usually associated with the administration of antibiotics. These "current outbreak" isolates were compared to 6000 stored "historic" isolates from 1984 to 1990. The isolates underwent genetic fingerprinting for strain typing, identification of previously identified molecular markers for increased virulence, and susceptibility to clindamycin and fluoroquinolones (levofloxacin, gatifloxacin, and moxifloxacin). A total of 187 isolates were obtained, and 96 (51%) belonged to a previously identified epidemic strain, BI/NAP1. This strain showed evidence of presence of virulence factors that was not present in . . . [Full Text of this Article]

Mobeen H. Rathore, MD, FAAP1 and Leslie L. Barton, MD, FAAP2
1 Pediatric Infectious Diseases, University of Florida and Wolfson Children’s Hospital, Jacksonville, FL
2 Pediatrics, University of Arizona, Tucson, AZ

 



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M. H. Rathore
Fluoroquinolone Use Impacts Nosocomial MRSA
AAP Grand Rounds, July 1, 2006; 16(1): 78 - 78.
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