Once the outbreak was identified, infection-control practices and procedures were reviewed and intensified. The majority of cases were debilitated and had serious underlying conditions, such as hematologic malignancies and renal failure requiring hemodialysis. Three cases had CDAD diagnosed endoscopically because the EIA for toxin A was negative. After its introduction, there were four additional cases. Further cases have not occurred since 30 September 1998.
Ongoing surveillance continues.
Centres using EIAs that only detect toxin A should be aware that CDAD caused by C. difficile that apparently produces only toxin B may occur. When the clinical scenario suggests CDAD but the diagnostic test is negative, it is also important to ensure that alternative diagnostic techniques be available. This outbreak was brought under control by implementing an alternative diagnostic test, and intensifying infection control interventions by focusing specifically on environmental decontamination, education, hand washing, and patient cohorting and isolation. It is unknown whether a similar situation may have contributed in part to this outbreak. Surawicz CM et al.