Evidence map›Paper›PMID 27533048›Full record

ArticlePloS one2016

An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.

Yvette H van Beurden, Olaf M Dekkers, Marije K Bomers, Annie M Kaiser, Robin van Houdt, Cornelis W Knetsch, Armand R J Girbes, Chris J J Mulder, Christina M J E Vandenbroucke-Grauls

Abstract read
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In one paragraph

Article in PloS one, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Risk factors forJournal of global health · 2017
    Pooled it
  2. Review
  3. Article
  4. AJournal of preventive medicine and hygiene · 2018
    Article
  5. Article
  6. Current challenges in the treatment of severeTherapeutic advances in gastroenterology · 2017
    Review
  7. Management of a cluster ofAntimicrobial resistance and infection control · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Yvette H van BeurdenDepartment of Medical Microbiology and Infection Control, VU University medical center, Amsterdam, The Netherlands.
Olaf M DekkersDepartment of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Marije K BomersDepartment of Internal Medicine, VU University medical center, Amsterdam, The Netherlands.
Annie M KaiserDepartment of Medical Microbiology and Infection Control, VU University medical center, Amsterdam, The Netherlands.
Robin van HoudtDepartment of Medical Microbiology and Infection Control, VU University medical center, Amsterdam, The Netherlands.
Cornelis W KnetschDepartment of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
Armand R J GirbesDepartment of Intensive Care, VU University medical center, Amsterdam, The Netherlands.
Chris J J MulderDepartment of Gastroenterology and Hepatology, VU University medical center, Amsterdam, The Netherlands.
Christina M J E Vandenbroucke-GraulsDepartment of Medical Microbiology and Infection Control, VU University medical center, Amsterdam, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAn outbreak of Clostridium difficile ribotype 027 infection (CDI) occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.

methodsCases (n = 79), diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316). Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10) was genotyped by Whole Genome Sequencing (WGS).

findingsWGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates). Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU) (OR: 2.4, 95% CI 1.0-5.6), longer length of stay (LOS), and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6). Analysis of patients who stayed at the ICU (35 cases; 51 controls), indicated that the use of selective decontamination of the digestive tract (SDD) and a longer LOS in the ICU were associated with CDI risk.

interpretationIn this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.

Indexed as

Disease OutbreaksAgedAged, 80 and overCase-Control StudiesClostridioides difficileClostridium InfectionsCross InfectionDecontaminationFemaleGastrointestinal TractHospitals, UniversityHumansIncidenceIntensive Care UnitsLength of StayMale

Identifiers

PMID27533048
PMCPMC4988663

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.