Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Manjula Meda; Nilangi Virgincar; Victoria Gentry; Amanda Walker; Neil Macdonald; Michaela Hooper; Simon Wells; Charlotte Anderson; David Garner; Shamma Mumtaz; Alyson Smith

doi:10.1016/j.ajic.2018.06.001

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Manjula Meda^*
, Nilangi Virgincar
, Victoria Gentry
, Amanda Walker
, Neil Macdonald
, Michaela Hooper
, Simon Wells
, Charlotte Anderson
, David Garner
, Shamma Mumtaz
, Alyson Smith

^*Corresponding author for this work

SE Health Protection

Research output: Contribution to journal › Review article › peer-review

4 Citations (Scopus)

Abstract

Background: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. Methods: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. Results: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. Conclusions: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.

Original language	English
Pages (from-to)	e7-e14
Journal	American Journal of Infection Control
Volume	47
Issue number	1
DOIs	https://doi.org/10.1016/j.ajic.2018.06.001
Publication status	Published - Jan 2019

Bibliographical note

Funding Information:
We would like to thank all the staff involved in this investigation?maternity staff; infection prevention and control (IPC) departments, and the pharmacy departments of both the hospitals?for their contributions in managing this outbreak and with data collection. We acknowledge the work done by the Microbiology registrar, Dr. W. Schilling, in working with the IPC team in processing the environmental samples, as well as colleagues from Public Health England who assisted in the investigation and the reference laboratories in England for undertaking the typing work.

Publisher Copyright:
© 2019

Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Clostridium difficile infection
Epidemiology
Maternity
Postpartum women
Pregnancy

Access to Document

10.1016/j.ajic.2018.06.001

Cite this

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title = "Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature",

abstract = "Background: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. Methods: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. Results: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. Conclusions: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.",

keywords = "Clostridium difficile infection, Epidemiology, Maternity, Postpartum women, Pregnancy",

author = "Manjula Meda and Nilangi Virgincar and Victoria Gentry and Amanda Walker and Neil Macdonald and Michaela Hooper and Simon Wells and Charlotte Anderson and David Garner and Shamma Mumtaz and Alyson Smith",

note = "Funding Information: We would like to thank all the staff involved in this investigation?maternity staff; infection prevention and control (IPC) departments, and the pharmacy departments of both the hospitals?for their contributions in managing this outbreak and with data collection. We acknowledge the work done by the Microbiology registrar, Dr. W. Schilling, in working with the IPC team in processing the environmental samples, as well as colleagues from Public Health England who assisted in the investigation and the reference laboratories in England for undertaking the typing work. Publisher Copyright: {\textcopyright} 2019 Copyright: Copyright 2019 Elsevier B.V., All rights reserved.",

year = "2019",

month = jan,

doi = "10.1016/j.ajic.2018.06.001",

language = "English",

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journal = "American Journal of Infection Control",

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AU - Meda, Manjula

AU - Virgincar, Nilangi

AU - Gentry, Victoria

AU - Walker, Amanda

AU - Macdonald, Neil

AU - Hooper, Michaela

AU - Wells, Simon

AU - Anderson, Charlotte

AU - Garner, David

AU - Mumtaz, Shamma

AU - Smith, Alyson

N1 - Funding Information: We would like to thank all the staff involved in this investigation?maternity staff; infection prevention and control (IPC) departments, and the pharmacy departments of both the hospitals?for their contributions in managing this outbreak and with data collection. We acknowledge the work done by the Microbiology registrar, Dr. W. Schilling, in working with the IPC team in processing the environmental samples, as well as colleagues from Public Health England who assisted in the investigation and the reference laboratories in England for undertaking the typing work. Publisher Copyright: © 2019 Copyright: Copyright 2019 Elsevier B.V., All rights reserved.

PY - 2019/1

Y1 - 2019/1

N2 - Background: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. Methods: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. Results: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. Conclusions: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.

AB - Background: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. Methods: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. Results: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. Conclusions: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.

KW - Clostridium difficile infection

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KW - Maternity

KW - Postpartum women

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JF - American Journal of Infection Control

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ER -

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature

Abstract

Bibliographical note

UN SDGs

Keywords

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