Publications

general outbreaks of infectious intestinal disease (iid) in hospitals, england and wales, 1992-2000.	between 1992 and 2000, 26.6% (1,396/5,257) of all general outbreaks of infectious intestinal disease (iid) reported to the public health laboratory service (phls) communicable disease surveillance centre (cdsc) occurred in hospitals. over 29,000 patients and staff were affected and the mortality risk was higher than for outbreaks in other settings [relative risk 2.00 (95% ci: 1.52-2.63) p<0.001]. person-to-person spread was the predominant mode of transmission. the mortality risk was highest in ...	2003	12495678
risk factors for the development of clostridium difficile toxin-associated diarrhoea: a pilot study.	this study was a pilot investigation of risk factors for the development of clostridium difficile toxin-associated diarrhoea and in particular the differential influence of antimicrobial agents. the study was a retrospective case-control design conducted at freeman hospital, newcastle upon tyne. cases were inpatients with stool positive c. difficile toxin diarrhoea and two controls were drawn for each case matched for age (+/- 5 years) and type of admission (emergency or elective). using conditi ...	2001	11760491
prospective evaluation of environmental contamination by clostridium difficile in isolation side rooms.	we determined prospectively the frequency, persistence and molecular epidemiology of clostridium difficile environmental contamination after detergent-based cleaning in side rooms used to isolate patients with c. difficile diarrhoea. approximately one-quarter of all environmental sites in side rooms sampled over four-week periods were contaminated with c. difficile. the overall side room prevalence of environmental c. difficile declined from 35% initially, to 24% in week 2, 18% in week 3, and 16 ...	2001	11716638
the rise of clostridium difficile: the effect of length of stay, patient age and antibiotic use.	hospitals in the uk have recently seen a marked increase in c. difficile for reasons which are unclear. reduced standards of hygiene, increasingly elderly patients, greater cephalosporin use and longer hospital stay have been suggested. we retrospectively studied all cases of c. difficile diarrhoea at princess margaret hospital, swindon, over two years. cephalosporins, patient age and los appeared unrelated to the rise in c. difficile; penicillins and macrolides were related. our policy of using ...	2000	10896804
contrasting incidence of clostridium difficile and other enteropathogens in aids patients in london and lusaka.		2000	10897357
clostridium difficile: an update on its epidemiology and role in hospital outbreaks in england and wales.	data from the surveillance system of general outbreaks of infectious intestinal disease and from laboratory reports collated by the communicable disease surveillance centre (cdsc) and requests for outbreak investigation by the phls anaerobe reference unit were used to evaluate the current epidemiology of clostridium difficile infection in england and wales. between january 1992 and december 1996, cdsc received 10,220 laboratory reports of c difficile isolation from patient's faeces and 26,873 of ...	1999	10204123
clostridium difficile in leicester hospital.		1999	10344091
an audit of the use of manual handling equipment and their microbiological flora--implications for infection control.	a review of the use of manual handling aids in two hospitals found equipment was employed on a multi-patient basis with inadequate cleaning. sampling with a casella slit sampler demonstrated frequent contamination by methicillin-resistant staphylococcus aureus and clostridium difficile of fabric aids. recommendations for care of equipment are made.	1999	10658808
detection of glycopeptide-resistant enterococci in routine diagnostic faeces specimens.	faeces received in a diagnostic laboratory were screened for glycopeptide-resistant enterococci (gre) on modified lewisham medium, with and without enrichment in enterococcosel broth. colonization by gre was detected in 102/838 patients (12.2%). in 74 (73%) of colonized patients gre were detected by both methods and in 28 (27%) they were detected only after enrichment. the carriage rate in hospitalized patients was 32% (93/289) compared with 2.3% (11/425) in the community (gp patients and food-h ...	1999	10462636
incidence and impact of clostridium difficile infection in the uk, 1993-1996.	questionnaires were sent to 360 uk medical microbiologists to determine the incidence of clostridium difficile infection in the uk between 1993-1996, and to establish the current laboratory testing protocols. replies were received from 104 laboratories (29% response rate), 86, 7, 4 and 3% of which are in england, scotland, wales and northern ireland, respectively. the laboratories serve a total of approximately 90,000 hospital beds (median 750). c. difficile testing was performed by 83% of the l ...	1998	9699137
antimicrobial associations of an outbreak of diarrhoea due to clostridium difficile.	an increased incidence of diarrhoea due to clostridium difficile (cdd) at the northern general hospital, sheffield, prompted an investigation into antibiotic use on the renal, medical and geriatric wards, those mostly affected. for the first half of 1997 affected patients on these wards were identified and data collected as to which antimicrobials they had taken between admission and diagnosis. rates were then calculated of the number of affected patients on a drug over the quantity prescribed ( ...	1998	9699138
human enteric pathogens identified in a london teaching hospital and a rural public health laboratory: 1994.	two microbiology laboratories, one serving an inner city hospital and one a rural public health laboratory, collected data on the outcome of examining faecal specimens in 1994. overall, 6.7% of the investigations were positive, but the rates were lower for hospital inpatients, for recently described pathogens, and in the absence of relevant clinical details; rates were higher for patients with a history of foreign travel. no benefit was gained by examining more than two specimens from any patien ...	1998	9782627
guidelines for optimal surveillance of clostridium difficile infection in hospitals.	the availability of surveillance data on c. difficile infection in hospitals in england and wales is being jeopardised by the trend not to culture the organism for diagnostic purposes. nhs trust laboratories that no longer have the ability to isolate c. difficile cannot investigate putative outbreaks or monitor antimicrobial susceptibilities. these laboratories may now need to rely on their local public health laboratory for such investigations. recent recommendations from the department of heal ...	1998	9854878
the effect of an enhanced infection-control policy on the incidence of clostridium difficile infection and methicillin-resistant staphyloccocus aureus colonization in acute elderly medical patients.	clostridium difficile (cd) infection and methicillin-resistant staphylococcus aureus (mrsa) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. management is by side-room isolation. ward closure may be required to control outbreaks.	1998	12675094
do patients with clostridium difficile need to be isolated?		1997	9211164
the distribution of clostridium difficile in the environment of south wales.	a large study of the distribution of clostridium difficile in the environment of the cardiff area of south wales was performed with a methodology designed to maximise recovery. a total of 2580 samples was taken, with 184 (7.1%) yielding isolates. the highest yield for c. difficile was obtained from river waters, with 14 (87.5%) of 16 samples from four rivers positive, and from sea water samples with 7 (44%) of 15 positive from six beaches on the bristol channel. in addition, 7 (46.7%) of 15 samp ...	1996	8683549
infectious intestinal disease in elderly people.	this paper analyses routinely available data on infectious intestinal diseases occurring in people aged 65 years and over in england and wales from 1990 to 1994. these data include annual reports of consultations with general practitioners in spotter practices collated by the royal college of general practitioners, notifications of food poisoning collated by the office of population censuses and surveys, hospital admissions extracted from hospital episode statistics data, reports of general outb ...	1996	8755672
cleaning up clostridium difficile infection.		1996	8813978
molecular typing of clostridium difficile.		1996	8854453
clostridium difficile diarrhoea.		1995	7738343
management and control of a large outbreak of diarrhoea due to clostridium difficile.	in the six-month period 1 november 1991 to 1 may 1992 175 patients developed diarrhoea due to clostridium difficile in three hospitals in manchester, uk. most patients (90%) were over 60 years old and had been admitted to acute geriatric or medical wards with other illnesses. infection is thought to have contributed to 17 deaths. twenty-two patients relapsed clinically after antibiotic treatment. the outbreak began in one ward and affected 15 patients and two nurses. during the following months ...	1994	7916358
identification of outbreak-associated and other strains of clostridium difficile by numerical analysis of sds-page protein patterns.	seventy-three cultures of clostridium difficile isolated both during, and in the period immediately following, an outbreak of infection in a group of three hospitals, were characterized by one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis (sds-page) of whole-cell proteins. each protein pattern was characterized by the presence of one or two dense bands which were highly reproducible. the protein patterns were used as the basis for a numerical analysis which divided the s ...	1994	8062865
trés difficile.		1993	8454879
surveillance of clostridium difficile infection.		1992	1285121
clostridium difficile infection in manchester.		1992	1285174
clostridium difficile in london and staffordshire.		1992	1285182
managing hospital infections.	major infections in hospitals may cause, or contribute to, patient deaths and, at best, disrupt hospital routines. elaine leaver describes the management response to a major infection in the hospital environment.	1992	10121488
an investigation into clostridium perfringens enterotoxin-associated diarrhoea.	an investigation was carried out to establish the incidence of diarrhoea associated with the presence of enterotoxigenic clostridium perfringens. the results indicate a high risk group, namely elderly hospitalized patients, who should be investigated for this organism in a similar way to clostridium difficile if symptoms occur. the significance of antibiotic association is suggested and cross-infection was shown to be a possibility. detection of the enterotoxin was accompanied in all cases by th ...	1991	1680904
clostridium difficile in an oncology unit.	in one year 21 new cases of clostridium difficile infection occurred on a paediatric oncology unit. eleven cases were in a two month period. this infection should be regarded as a communicable disease. investigations to detect c difficile should be carried out in children with malignant disease who have diarrhoea.	1988	3415338
investigation of clostridium difficile diarrhoea in a district general hospital: room for improvement?	a retrospective survey of case-notes was carried out on all patients investigated for possible clostridium difficile diarrhoea during a 1-month period at a district general hospital. seven of 29 patients probably had the disease, but no case of pseudomembranous colitis was documented. delay in reporting and discrepancies between culture and cytotoxin results contributed in several cases to mismanagement. in 14 of 16 cases negative by culture and cytotoxin, a plausible non-microbiological case fo ...	1987	2891751