Pneumologie 2009; 63 - P276
DOI: 10.1055/s-0029-1213875

Lessons learned from a prolonged outbreak of Clostridium difficile diarrhoea among patients with tuberculosis

H Hoffmann 1, S Thiel 1, L Stoiber 1, K Häußinger 2, A Neher 2
  • 1Supranationales Referenzlabor für Tuberkulose, Asklepios Fachkliniken München-Gauting
  • 2Pneumologische Abteilung, Asklepios Fachkliniken München-Gauting

Clostridium difficile diarrhoea (CDD) is a nosocomial infection. Most routine disinfectants do not kill the spores of the pathogen. CDD is mostly seen in hospitalized patients undergoing antimicrobial therapy. Among classical anti-tuberculosis drugs, only rifampin has been associated with CDD. However, increasing proportions of cases with resistant tuberculosis or infections by non-tuberculous mycobacteria has led to rising consumption of alternative antibiotics like chinolones or macrolides which confer a higher risk of CDD. Accordingly, the risk of CDD among TB patients has risen.

In June 2007, a series of cases with CDD started in our TB department cumulating in an outbreak situation that lasted until Mai 2008. Initially, three patients were afflicted. After implementation of strict isolation measures, only one new case occurred during the next 4 month. In November 2007 and in April to May 2008, two further outbreaks occurred affecting five and four patients, respectively. Over the twelve month period, the monthly rate of C. difficile detection (1.4/m) was seven times higher than usual (<0,2/m). Most of the patients suffered from severe abdominal pain and watery diarrhoea. No case of severe pseudomembranous colitis occurred. C. difficile isolates were genotyped at the Robert-Koch-Institute. All belonged to ribotype (RT 001) suggesting a prolonged clonal outbreak. In interdisciplinary meetings with experts from internal medicine, nursery, infection control, and microbiology, risk factors were identified and a catalogue of measures was assembled in order to stop the outbreak.

After the implementation of intensive infection control measures, no new case of CDD was observed at our TB department since May 2008. To the best of our knowledge, this is the first outbreak of CDD reported among TB patients in Germany. Risk factors identified and measures taken to stop the outbreak will be presented and discussed in detail.