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.
A series of measures were implemented, in a secondary/tertiary-care hospital in Quebec, to control an epidemic of nosocomial Clostridium difficile-associated disease (n-CDAD) caused by a virulent strain; these measures included the development of a nonrestrictive antimicrobial stewardship program. Interrupted time-series analysis was used to evaluate the impact of these measures on n-CDAD incidence. From 2003-2004 to 2005-2006, total and targeted antibiotic consumption, respectively, decreased by 23% and 54%, and the incidence of n-CDAD decreased by 60%. No change in n-CDAD incidence was noted after strengthening of infection control procedures (P=.63), but implementation of the antimicrobial stewardship program was followed by a marked reduction in incidence (P=.007). This suggests that nonrestrictive measures to optimize antibiotic usage can yield exceptional results when physicians are motivated and that such measures should be a mandatory component of n-CDAD control. The inefficacy of infection control measures targeting transmission through hospital personnel might be a result of their implementation late in the epidemic, when the environment was heavily contaminated with spores.
Department of Microbiology and Infectious Diseases, University of Sherbrooke, Sherbrooke, Quebec, Canada. louis.valiquette@usherbrooke.ca
Louis
L
Valiquette
Benoit
B
Cossette
Marie-Pierre
MP
Garant
Hassan
H
Diab
Jacques
J
Pépin
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000472:pathogenicity*; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents