某醫學中心成人急診加護病房困難梭狀桿菌（Clostridium difficile）偽群聚感染事件調查

Clostridium difficile is part of the normal flora of the gut and may lead to development of C. difficile-associated diarrhea (CDAD) in patients with prior antibiotic exposure. Between December 2007 and February 2008, a cluster of CDAD involving 5 patients admitted from the community to the intensive care unit of Emergency Department (EDICU) of Kaohsiung Chang Gung Memorial Hospital was identified. All of them were elderly, experiencing sepsis with respiratory failure and with prior antibiotic exposure. To contain a presumed CDAD outbreak, infection control measures immediately taken by the EDICU included implementation of contact precautions, hand washing instead of dry-cleaning hand hygiene among staff, minimizing antibiotic use, closely monitoring possible emerging CDAD cases and environmental cleaning. However, subsequent DNA analysis using infrequent-restriction-site PCR (IRS-PCR) disclosed different DNA macro-fragment patterns among these 5 C. difficile isolates, indicating that this was a pseudo-outbreak of CDAD. This pseudo-outbreak suggested the widespread existence of multiclonal C. difficile isolates in the community, Evaluation of the amplitude of C. difficile carriers (especially in elderly with multiple co-morbidities) and impacts of this epidemiologic findings in southern Taiwan is in urgent need, so that the health authorities can map out an effective combat strategy accordingly.