Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital.
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.
Kallen
Alexander J
AJ
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
Thompson
Angela
A
Ristaino
Polly
P
Chapman
Leigh
L
Nicholson
Ainsley
A
Sim
Bich-Thuy
BT
Lessa
Fernanda
F
Sharapov
Umid
U
Fadden
Elaine
E
Boehler
Richard
R
Gould
Carolyn
C
Limbago
Brandi
B
Blythe
David
D
McDonald
L Clifford
LC
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
D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones