Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T01:01:42.869Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Alexander J. Kallen ,
Angela Thompson ,
Polly Ristaino ,
Leigh Chapman ,
Ainsley Nicholson ,
Bich-Thuy Sim ,
Fernanda Lessa ,
Umid Sharapov ,
Elaine Fadden  and
Richard Boehler
...Show all authors
Alexander J. Kallen*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Angela Thompson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Polly Ristaino
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Leigh Chapman
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Ainsley Nicholson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Bich-Thuy Sim
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Fernanda Lessa
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Umid Sharapov
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Elaine Fadden
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Richard Boehler
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Carolyn Gould
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Brandi Limbago
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Blythe
Affiliation:
Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road Northeast, Mail Stop A-35, Atlanta, GA 30333 (AKallen@cdc.gov)
Get access Rights & Permissions [Opens in a new window]

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 3 , March 2009 , pp. 264 - 272
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Eng J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
2.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Eng J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
3.Kuijper, EJ, Coignard, B, Tüll, P. Emergence of Clostridium difficile-associated disease in North America and Europe. Clin Microbiol Infect 2006;12(Suppl 6):2–18.CrossRefGoogle Scholar
4.Kazakova, SV, Ware, K, Baughman, B, et al.A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile. Clin Infect Dis 2006;166:2518–2524.Google Scholar
5.Centers for Disease Control and Prevention. Data and statistics about Clostridium difficile infections. Available at: http://www.cdc.gov/ncidod/dhqp/id_Cdiff_data.html. Accessed March 10, 2008.Google Scholar
6.Warny, M, Pepin, J, Fang, A, et al.Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:1079–1084.Google Scholar
7.Zafar, AB, Gaydos, LA, Furlong, WB, Nguyen, MH, Mennonna, PA. Effectiveness of infection control program in controlling nosocomial Clostridium difficile. Am J Infect Control 1998;26:588–593.CrossRefGoogle ScholarPubMed
8.Mayfield, JL, Leet, T, Miller, J, Mundy, LM. Environmental control to reduce transmission of Clostrdium difficile. Clin Infect Dis 2000;31:995–1000.CrossRefGoogle Scholar
9.Pepin, J, Saheb, N, Coulombe, M-A, et al.Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.CrossRefGoogle ScholarPubMed
10.Johnson, S, Samore, MH, Farrow, KA, et al.Epidemics of diarrhea caused by clindamycin-resistant strain of Clostrdium difficile in four hospitals. N Eng J Med 1999;341:1645–1651.Google Scholar
11.McNulty, C, Logan, M, Donald, IP, et al.Successful control of Clostridium difficile infection in an elderly care unit through use of a restrictive antibiotic policy. J Antimicrob Chemother 1997;40:707–711.Google Scholar
12.Carling, P, Fung, T, Killion, A, Terrin, N, Barza, M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699–706.Google Scholar
13.Gerding, DN, Johnson, S, Peterson, L, Mulligan, ME, Silva, J. Clostridium diffidle-associaled diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.CrossRefGoogle ScholarPubMed
14.Briller, P, Shank, B, Lind, L, et al.Moxifloxacin therapy as a risk factor for Clostridium difficile-associated disease during an outbreak: attempts to control a new epidemic strain. Infect Control Hosp Epidemiol 2007;28:198–201.Google Scholar
15.Gaynes, R, Rimland, D, Killum, E, et al.Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 2004;38:640–645.Google Scholar
16.McDonald, LC, Coigard, B, Dubberke, E, et al.Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.Google Scholar
17.Rupnik, M, Avesani, V, Jane, M, von Eichel-Streiber, C, Delmee, M. A novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. J Clin Microbiol 1998;36:2240–2247.CrossRefGoogle ScholarPubMed
18.Stubbs, S, Rupnik, M, Gibert, M, Brazier, J, Duerden, B, Popoff, M. Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile. FEMS Microbiol Lett 2000;186:307–312.CrossRefGoogle ScholarPubMed
19.Killgore, G, Thompson, A, Johnson, S, et al.Comparison of seven techniques for typing international epidemic strains of Clostridium difficile: restriction endonuclease analysis, pulsed-field gel electrphoresis, PCR-ribotyping, multilocus sequence typing, multilocus variable-number tandem-repeat analysis, amplified fragment length polymorphism, and surface layer protein A sequence typing. J Clin Microbiol 2008;46:431–437.CrossRefGoogle Scholar
20.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infections in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis 2006;12:409–415.CrossRefGoogle ScholarPubMed
21.Chandler, RE, Hedberg, K, Cieslak, PR. Clostrdium difficile-associated disease in Oregon: increasing incidence and hospital-level risk factors. Infect Control Hosp Epidemiol 2007;28:116–122.CrossRefGoogle Scholar
22.Adams, DA, Riggs, MM, Donskey, CJ. Effect of fluoroquinolone treatment on growth of and toxin production by epidemic and nonepidemic Clostridium difficile strains in the cecal contents of mice. Antimicrob Agents Chemother 2007;51:2673–2678.Google Scholar
23.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Guidelines for isolation precautions: preventing transmission of infectious agents in healthcare settings, June 2007. Healthcare Infection Control Practices Advisory Committee. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf Accessed March 10, 2008.Google Scholar
24.Climo, MW, Isreal, DS, Wong, ES, Williams, D, Coudron, P, Markowitz, SM. Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost. Ann Intern Med 1998;128:989–995.Google Scholar
25.Pear, SM, Williamson, TH, Bettin, KM, Gerding, DN, Galgiani, JN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994;120:272–277.CrossRefGoogle ScholarPubMed
26.Valiquette, L, Cossette, B, Garant, M-P, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45(Suppl 2):S112–S121.Google Scholar
27.Muto, CA, Blank, MK, Marsh, JW, et al.Control of an outbreak of infection with the hypervirulent Clostrdium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis 2007;45:1266–1273.Google Scholar
28.Leonard, J, Marshal, JK, Moayyedi, P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol 2007;102:2047–2056.Google Scholar
29.Jump, RLP, Pultz, MJ, Donskey, CJ. Vegetative Clostridium difficile survives in room air on moist surfaces and in gastric contents with reduced acidity: a potential mechanism to explain the association between proton pump inhibitors and C. difficile-associated diarrhea. Antimicrob Agents Chemother 2007;51:2883–2887.Google Scholar
30.Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonlad, LC, Fraser, VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45:1543–1549.Google Scholar
31.Dubberke, ER, Reske, KA, Olsen, MA, et al.Evaluation of Clostridium diffidle-associated pressure as a risk factor for C. difficile-associated disease. Arch Intern Med 2007;167:1092–1097.Google Scholar