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J Hosp Infect. 2015 Sep;91(1):74-80. doi: 10.1016/j.jhin.2015.05.013. Epub 2015 Jun 21.

Effects of fluoroquinolone restriction (from 2007 to 2012) on Clostridium difficile infections: interrupted time-series analysis.

Author information

1
Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK. Electronic address: jayanta.sarma@nhs.net.
2
Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK.
3
Department of Pharmacy, Northumbria Healthcare NHS Foundation Trust, UK.

Abstract

BACKGROUND:

Antimicrobial stewardship is a key component in the reduction of healthcare-associated infections, particularly Clostridium difficile infection (CDI). We successfully restricted the use of cephalosporins and, subsequently, fluoroquinolones. From an endemically high level of >280 cases per year in 2007-08, the number of CDIs reduced to 72 cases in 2011-12.

AIM:

To describe the implementation and impact of fluoroquinolone restriction on CDI.

METHODS:

This was an interrupted time-series analysis pre and post fluoroquinolone restriction for 60 months based on a Poisson distribution model.

FINDINGS:

In June 2008, fluoroquinolone consumption halved to about 5 defined daily doses (DDD) per 100 occupied bed-days (OBD). This was followed by a significant fall in CDI number [rate ratio (RR): 0.332; 95% confidence interval (CI): 0.240-0.460] which remained low over the subsequent months. Subsequently, fluoroquinolone consumption was further reduced to about 2 DDD/100 OBD in June 2010 accompanied by further reduction in CDI rate (RR: 0.394; 95% CI: 0.199-0.781). In a univariate Poisson model the CDI rate was associated with fluoroquinolone usage (RR: 1.086; 95% CI: 1.077-1.094).

CONCLUSION:

We conclude that in an environment where cephalosporin usage is already low, the reduction in fluoroquinolone usage was associated with an immediate, large, and significant reduction in CDI cases.

KEYWORDS:

Antimicrobial stewardship; Clostridium difficile; Fluoroquinolones; Interrupted time-series analysis

PMID:
26169793
DOI:
10.1016/j.jhin.2015.05.013
[Indexed for MEDLINE]

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