Management of a Cluster of Infections Among Patients with Osteoarticular Infections

Overview

Journal Antimicrob Resist Infect Control

Publisher Biomed Central

Specialty Infectious Diseases

Date 2017 Feb 28

PMID 28239451

Citations 3

Authors

Jacqueline Farber

Sebastian Illiger

Fabian Berger

Barbara Gartner

Lutz von Muller

Christoph H Lohmann

Katja Bauer

Christina Grabau

Stefanie Zibolka

Dirk Schluter

Gernot Geginat

Affiliations

Soon will be listed here.

Abstract

Background: Here we describe a cluster of hospital-acquired infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of CDI.

Methods: Epidemiological analysis included typing of strains and analysis of possible patient to patient transmission. Infection control measures comprised strict isolation of CDI patients, additional hand washings, and intensified environmental cleaning with sporicidal disinfection. In addition an antibiotic stewardship program was implemented in order to prevent the use of CDI high risk antimicrobials such as fluoroquinolones, clindamycin, and cephalosporins.

Results: The majority of CDI ( = 15) were caused by ribotype 027 (RT027). Most RT027 isolates ( = 9) showed high minimal inhibitory concentrations (MIC) for levofloxacin, clindamycin, and remarkably to rifampicin, which were all used for the treatment of osteoarticular infections. Epidemiological analysis, however, revealed no closer genetic relationship among the majority of RT027 isolates. The incidence of CDI was reduced only when a significant reduction in the use of fluoroquinolones ( = 0.006), third generation cephalosporins ( = 0.015), and clindamycin ( = 0.001) was achieved after implementation of an intensified antibiotic stewardship program which included a systematic review of all antibiotic prescriptions.

Conclusion: The successful reduction of the CDI incidence demonstrates the importance of antibiotic stewardship programs focused on patients treated for osteoarticular infections.

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