1. Complete Restriction of Fluoroquinolone Use to Control an Outbreak ofClostridium difficileInfection at a Community Hospital
- Author
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David Blythe, Fernanda C. Lessa, Elaine Fadden, L. Clifford McDonald, Leigh A. Chapman, Brandi Limbago, Carolyn V. Gould, Bich Thuy Sim, Polly Ristaino, Umid M. Sharapov, Angela Thompson, Richard Boehler, Ainsley C. Nicholson, and Alexander J. Kallen
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Epidemiology ,Disease Outbreaks ,Cohort Studies ,Internal medicine ,medicine ,Humans ,Infection control ,Intensive care medicine ,Retrospective Studies ,Antibacterial agent ,Cross Infection ,Clostridioides difficile ,business.industry ,Outbreak ,Retrospective cohort study ,Clostridium difficile ,Community hospital ,Anti-Bacterial Agents ,Infectious Diseases ,Case-Control Studies ,Cohort ,Clostridium Infections ,business ,Fluoroquinolones ,Cohort study - 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-onsetClostridium difficileinfection (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.
- Published
- 2009
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