Clostridium difficile Infection: The role of antibiotics in outbreak

264 Pages·2014·3.87 MB·English

by  Sylvia Brigitte Debast

Sylvia Debast
Clostridium difficile Infection:
The role of antibiotics in
outbreak control, epidemiology
and treatment

Sylvia Debast
Clostridium difficile Infection:
The role of antibiotics in
outbreak control, epidemiology
and treatment
Colofon
ISBN/EAN: 978-90-9028054-7
The copyright of the published articles has been
transferred to the respective journals or publishers.
© 2014, S.B. Debast, Amersfoort, the Netherlands.
All rights reserved. No part of this publication
may be reproduced, stored in a retrieval system, or
transmitted in any form or by any means without
prior permission of the author.
Clostridium difficile Infection:
The role of antibiotics in outbreak control,
epidemiology and treatment
Proefschrift
Ter verkrijging van de graad van Doctor
aan de Universiteit Leiden
op gezag van Rector Magnificus prof. mr. C.J.J.M. Stolker,
volgens besluit van het College voor Promoties
te verdedigen op donderdag 13 februari 2014
klokke 13.45 uur
door:
Sylvia Brigitte Debast
geboren 30 juli 1966
te Xanten (Duitsland)
Promotiecommissie
Promotor: Prof. dr. E.J. Kuijper
Overige leden: Prof. dr. J.T. van Dissel
Prof. dr. A. Voss, Radboud Universiteit Nijmegen
Prof. dr. F. van Knapen, Universiteit Utrecht
Vita bevis,
ars vero Ionga,
occasio autem praeceps,
experimentum
periculosum,
iudicium difficile.
Nec solum se ipsum
praestare oportet
oportuna facientem,
sed et aegrum et
assidentes et exteriora.
Hippocrates
Vertaald en besproken in:
Medisch Contact 1967: 35; 785-787

i
Table of Contents
Introduction
Chapter 1. General Introduction 3
Introduction 4
Clinical disease in humans 5
Pathogenesis 8
Epidemiology 12
Laboratory diagnosis 14
Antibiotics and CDI 19
Therapeutic options 19
Infection Control 21
Economics and CDI 23
Outline of this thesis 24
Aim of the studies 27
References 28
Outbreak control
Chapter 2. Successful combat of an outbreak due to
Clostridium difficile PCR-ribotype 027 and recognition of
specific risk factors 43
Chapter 3. Effect on diagnostic yield of repeated stool testing during
outbreaks of Clostridium difficile-associated disease 61
Chapter 4. PCR-ribotype-specific risk factors and outcome in
an outbreak with 2 different Clostridium difficile Types
simultaneously in one hospital 69
Epidemiology
Chapter 5. Human Clostridium difficile-associated disease
PCR-ribotype 078 toxinotype V identified in Dutch
food-producing swine 91
ii