title: Effects of fluoroquinolone restriction (from 2007 to 2012) on Clostridium difficile infections: interrupted time-series analysis.
abstract: BACKGROUND
  Antimicrobial stewardship is a key component in the reduction of healthcare-associated infections, particularly Clostridium difficile infection (CDI). We successfully restricted the use of cephalosporins and, subsequently, fluoroquinolones. From an endemically high level of >280 cases per year in 2007-08, the number of CDIs reduced to 72 cases in 2011-12.
  
  
  OBJECTIVE
  To describe the implementation and impact of fluoroquinolone restriction on CDI.
  
  
  METHODS
  This was an interrupted time-series analysis pre and post fluoroquinolone restriction for 60 months based on a Poisson distribution model.
  
  
  RESULTS
  In June 2008, fluoroquinolone consumption halved to about 5 defined daily doses (DDD) per 100 occupied bed-days (OBD). This was followed by a significant fall in CDI number [rate ratio (RR): 0.332; 95% confidence interval (CI): 0.240-0.460] which remained low over the subsequent months. Subsequently, fluoroquinolone consumption was further reduced to about 2 DDD/100 OBD in June 2010 accompanied by further reduction in CDI rate (RR: 0.394; 95% CI: 0.199-0.781). In a univariate Poisson model the CDI rate was associated with fluoroquinolone usage (RR: 1.086; 95% CI: 1.077-1.094).
  
  
  CONCLUSIONS
  We conclude that in an environment where cephalosporin usage is already low, the reduction in fluoroquinolone usage was associated with an immediate, large, and significant reduction in CDI cases.
authors.affiliation: Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK. Electronic address: jayanta.sarma@nhs.net.
authors.forename: J B
authors.initials: JB
authors.lastname: Sarma
authors.affiliation: Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK.
authors.forename: B
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK.
authors.forename: V
authors.initials: V
authors.lastname: Cleeve
authors.affiliation: Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK.
authors.forename: D
authors.initials: D
authors.lastname: Tate
authors.affiliation: Department of Microbiology, Northumbria Healthcare NHS Foundation Trust, UK.
authors.forename: T
authors.initials: T
authors.lastname: Oswald
authors.affiliation: Department of Pharmacy, Northumbria Healthcare NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Woolfrey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002511:Cephalosporins / Q000494:pharmacology; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004363:Drug Utilization / Q000639:trends; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D006801:Humans; D017053:Infection Control / Q000379:methods; D065186:Interrupted Time Series Analysis / Q000379:methods; D008297:Male; D021521:Ribotyping / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones
keywords: Antimicrobial stewardship; Clostridium difficile; Fluoroquinolones; Interrupted time-series analysis