title: Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost.
abstract: BACKGROUND
  Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.
  
  
  OBJECTIVE
  To characterize the impact of hospital-wide clindamycin restriction on the incidence of Clostridium difficile-associated diarrhea and on antimicrobial prescribing practices.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  University-affiliated Veterans Affairs Medical Center.
  
  
  METHODS
  Hospitalized patients with symptomatic diarrhea.
  
  
  METHODS
  Clinical data on individual patients and data on antibiotic use were obtained from hospital pharmacy records. Hospital-wide use of antimicrobial agents was monitored. Isolates of C. difficile underwent antimicrobial susceptibility testing and molecular typing.
  
  
  RESULTS
  An outbreak of C. difficile-associated diarrhea was caused by a clonal isolate of clindamycin-resistant C. difficile and was associated with increased use of clindamycin. Hospital-wide requirement of approval by an infectious disease consultant of clindamycin use led to an overall reduction in clindamycin use, a sustained reduction in the mean number of cases of C. difficile-associated diarrhea (11.5 cases/month compared with 3.33 cases/month; P < 0.001), and an increase in clindamycin susceptibility among C. difficile isolates (9% compared with 61%; P < 0.001). A parallel increase was noted in the use of and costs associated with other antibiotics with antianaerobic activity, including cefotetan, ticarcillin-clavulanate, and imipenem-cilastin. The hospital realized overall cost savings as a result of the decreased incidence of C. difficile-associated diarrhea.
  
  
  CONCLUSIONS
  Hospital formulary restriction of clindamycin is an effective way to decrease the number of infections due to C. difficile. It can also lead to a return in clindamycin susceptibility among isolates and can effect cost savings to the hospital.
authors.affiliation: Hunter Holmes McGuire Veterans Affairs Medical Center, Medical College of Virginia, and Virginia Commonwealth University, Richmond 23249, USA.
authors.forename: M W
authors.initials: MW
authors.lastname: Climo
authors.forename: D S
authors.initials: DS
authors.lastname: Israel
authors.forename: E S
authors.initials: ES
authors.lastname: Wong
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.forename: P
authors.initials: P
authors.lastname: Coudron
authors.forename: S M
authors.initials: SM
authors.lastname: Markowitz
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D002981:Clindamycin / Q000191:economics* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects; D003015:Clostridium Infections / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D004363:Drug Utilization / Q000191:economics; D006801:Humans; D015994:Incidence; D010607:Pharmacy Service, Hospital / Q000191:economics*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin