PEDIATRICS Vol. 71 No. 6 June 1983, pp. 935-941
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An Outbreak of Clostridium difficile Necrotizing Enterocolitis: A Case for Oral Vancomycin Therapy?

V. K.M. Han MB1, H. Sayed MD1, G. W. Chance MB1, D. G. Brabyn MB ChB1, and W. A. Shaheed MB, ChB1

1 From the Departments of Paediatrics and Microbiology, University of Western Ontario, London, Ontario Canada

During a 2-month period, 13 infants in this neonatal intensive care unit developed necrotizing enterocolitis, increasing the prevalence in inborns from 5.2 to 20.5/1,000 live births. Fifty-seven perinatal and neonatal factors, many of which have previously been associated with necrotizing enterocolitis, were compared between the infants with necrotizing enterocolitis and 17 unaffected inborn control infants admitted concurrently. Clostridium difficile cytotoxin was detected in the stools of 12 affected infants (92.3%) in comparison with two control infants (11.8%) (P < .001), and the organism was isolated in eight affected neonates (61.5%) compared to none of the control infants (P < .001). The outbreak was terminated upon institution of oral vancomycin therapy in cases and infant contacts, and strict antiinfective measures in the neonatal intensive care unit. This indicates an etiologic role of C difficile in the outbreak. Oral vancomycin in the management of necrotizing enterocolitis was assessed by therapeutic response, drug levels, and occurrence of side effects. Oral vancomycin therapy is indicated in necrotizing enterocolitis outbreaks in units where C difficile is endemic.

Key Words: Clostridium difficile • necrotizing enterocolitis • vancomycin

Submitted on April 9, 1982
Accepted on August 25, 1982




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