title: Unnecessary antimicrobial use in patients with current or recent Clostridium difficile infection.
abstract: OBJECTIVE
  To determine the fraction of unnecessary antimicrobial use among patients with current and/or recent Clostridium difficile infection (CDI).
  
  
  METHODS
  Retrospective review from January 2004 through December 2006.
  
  
  METHODS
  Minneapolis Veterans Affairs Medical Center (MVAMC).
  
  
  METHODS
  Patients with new-onset CDI diagnosed at the MVAMC without another CDI diagnosis in the prior 30 days.
  
  
  METHODS
  Pharmacy and medical records were reviewed to identify incident CDI cases, non-CDI antimicrobial use during and up to 30 days after completion of CDI treatment, and patient characteristics. Two infectious disease physicians independently assessed non-CDI antimicrobial use, which was classified as unnecessary if not fully indicated. Factors associated with only unnecessary use were identified through univariable and multivariable analysis.
  
  
  RESULTS
  Of 246 patients with new-onset CDI, 141 (57%) received non-CDI antimicrobials during and/or after their CDI treatment, totaling 2,147 antimicrobial days and 445 antimicrobial courses. The two reviewers agreed regarding the necessity of antimicrobials in more than 99% of antimicrobial courses (85% initially, 14% after discussion). Seventy-seven percent of patients received at least 1 unnecessary antimicrobial dose, 26% of patients received only unnecessary antimicrobials, and 45% of total non-CDI antimicrobial days included unnecessary antimicrobials. The leading indications for unnecessary antimicrobial use were putative urinary tract infection and pneumonia. Drug classes frequently used unnecessarily were fluoroquinolones and β-lactams.
  
  
  CONCLUSIONS
  Twenty-six percent of patients with recent CDI received only unnecessary (and therefore potentially avoidable) antimicrobials. Heightened awareness and caution are needed when antimicrobial therapy is contemplated for patients with recent CDI.
authors.affiliation: Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA. megans@umn.edu
authors.forename: Megan K
authors.initials: MK
authors.lastname: Shaughnessy
authors.forename: William H
authors.initials: WH
authors.lastname: Amundson
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuskowski
authors.forename: Douglas D
authors.initials: DD
authors.lastname: DeCarolis
authors.forename: James R
authors.initials: JR
authors.lastname: Johnson
authors.forename: Dimitri M
authors.initials: DM
authors.lastname: Drekonja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile; D016001:Confidence Intervals; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D017678:Sex Distribution; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
chemical_list: D000890:Anti-Infective Agents