Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital.

Abstract

OBJECTIVE:

To review the effect of interventions, including a complete restriction in the use of fluoroquinolones (FQs), used to control an outbreak of hospital-onset Clostridium difficile infection (HO-CDI) caused primarily by the epidemic North American pulsed-field gel electrophoresis type 1 strain.

DESIGN:

Retrospective cohort and case-control study of all episodes of HO-CDI both before and after 2 interventions.

SETTING:

Community hospital; January 1, 2005, through March 31, 2007. Interventions. Complete, 5-month, facility-wide restriction of fluoroquinolone use, during which a change in the environmental-services contractor occurred.

RESULTS:

During a 27-month period, 319 episodes of HO-CDI occurred. The hospital-wide mean defined daily doses of antimicrobials decreased 22% after restricting FQ use, primarily because of a 66% decrease in the use of FQs. The interventions were also associated with a significant change in the HO-CDI incidence trends and with an absolute decrease of 22% in HO-CDI cases caused by the epidemic strain (from 66% before the intervention period to 44% during and after the intervention period; P=.02). Univariate analysis revealed that case patients with HO-CDI due to the epidemic strain were more likely than control patients, who did not have diarrhea, to receive a FQ, whereas case patients with HO-CDI due to a nonepidemic strain were not. However, FQ use was not significantly associated with HO-CDI in multivariable analysis.

CONCLUSIONS:

An outbreak of epidemic-strain HO-CDI was controlled at a community hospital after an overall decrease in antimicrobial use, primarily because of a restriction of FQ use and a change in environmental-services contractors. The restriction of FQ use may be useful as an adjunct control measure in a healthcare facilities during outbreaks of epidemic-strain HO-CDI.

• Authors: Alexander J Kallen, Angela Thompson, Polly Ristaino, Leigh Chapman, Ainsley Nicholson, Bich-Thuy Sim, Fernanda Lessa, Umid Sharapov, Elaine Fadden, Richard Boehler, Carolyn Gould, Brandi Limbago, David Blythe, L Clifford McDonald
• Journal: Infection control and hospital epidemiology (Infect Control Hosp Epidemiol) Vol. 30 Issue 3 Pg. 264-72 (Mar 2009) ISSN: 1559-6834 [Electronic] United States
• PMID: 19215193 (Publication Type: Journal Article)

Chemical References

• Anti-Bacterial Agents
• Fluoroquinolones

Topics

• Anti-Bacterial Agents (therapeutic use)
• Case-Control Studies
• Clostridioides difficile (physiology)
• Clostridium Infections (drug therapy, epidemiology, prevention & control)
• Cohort Studies
• Cross Infection (epidemiology, microbiology)
• Disease Outbreaks
• Fluoroquinolones (therapeutic use)
• Humans
• Retrospective Studies