title: Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital.
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.
  
  
  METHODS
  Retrospective cohort and case-control study of all episodes of HO-CDI both before and after 2 interventions.
  
  
  METHODS
  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.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. AKallen@cdc.gov
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kallen
authors.forename: Angela
authors.initials: A
authors.lastname: Thompson
authors.forename: Polly
authors.initials: P
authors.lastname: Ristaino
authors.forename: Leigh
authors.initials: L
authors.lastname: Chapman
authors.forename: Ainsley
authors.initials: A
authors.lastname: Nicholson
authors.forename: Bich-Thuy
authors.initials: BT
authors.lastname: Sim
authors.forename: Fernanda
authors.initials: F
authors.lastname: Lessa
authors.forename: Umid
authors.initials: U
authors.lastname: Sharapov
authors.forename: Elaine
authors.initials: E
authors.lastname: Fadden
authors.forename: Richard
authors.initials: R
authors.lastname: Boehler
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gould
authors.forename: Brandi
authors.initials: B
authors.lastname: Limbago
authors.forename: David
authors.initials: D
authors.lastname: Blythe
authors.forename: L Clifford
authors.initials: LC
authors.lastname: McDonald
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D016360:Clostridioides difficile / Q000502:physiology*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones