Complete Restriction of Fluoroquinolone Use to Control an Outbreak of Clostridium difficile Infection at a Community Hospital

被引:69
作者
Kallen, Alexander J. [1 ,2 ]
Thompson, Angela [1 ]
Ristaino, Polly [4 ]
Chapman, Leigh [4 ]
Nicholson, Ainsley [1 ]
Sim, Bich-Thuy [1 ]
Lessa, Fernanda [1 ,2 ]
Sharapov, Umid [2 ,3 ]
Fadden, Elaine [4 ]
Boehler, Richard [4 ]
Gould, Carolyn [1 ]
Limbago, Brandi [1 ]
Blythe, David [5 ]
McDonald, L. Clifford [1 ]
机构
[1] Ctr Dis Control & Prevent, Natl Ctr Preparedness Detect & Control Infect Dis, Div Healthcare Qual Promot, Atlanta, GA USA
[2] Ctr Dis Control & Prevent, Off Workforce & Career Dev, Epidem Intelligence Serv, Atlanta, GA USA
[3] Ctr Dis Control & Prevent, Natl Ctr Zoonot Vector Borne & Enter Dis, Div Foodborne Bacterial & Mycot Dis, Atlanta, GA USA
[4] St Joseph Med Ctr, Towson, MD USA
[5] Maryland Dept Hlth & Mental Hyg, Baltimore, MD USA
关键词
NORTH-AMERICA; RISK-FACTOR; DIARRHEA; DISEASE; EPIDEMIC; STRAIN; CLINDAMYCIN; TOXIN; ASSOCIATION; EMERGENCE;
D O I
10.1086/595694
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
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.
引用
收藏
页码:264 / 272
页数:9
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