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Complete Restriction of Fluoroquinolone Use to Control an Outbreak of Clostridium difficile Infection at a Community Hospital

Published online by Cambridge University Press:  02 January 2015

Alexander J. Kallen ,
Angela Thompson ,
Polly Ristaino ,
Leigh Chapman ,
Ainsley Nicholson ,
Bich-Thuy Sim ,
Fernanda Lessa ,
Umid Sharapov ,
Elaine Fadden  and
Richard Boehler
...Show all authors
Alexander J. Kallen*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Angela Thompson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Polly Ristaino
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Leigh Chapman
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Ainsley Nicholson
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Bich-Thuy Sim
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Fernanda Lessa
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia
Umid Sharapov
Affiliation:
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Elaine Fadden
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Richard Boehler
Affiliation:
Saint Joseph Medical Center, Towson, Maryland
Carolyn Gould
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Brandi Limbago
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
David Blythe
Affiliation:
Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
L. Clifford McDonald
Affiliation:
Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
1600 Clifton Road Northeast, Mail Stop A-35, Atlanta, GA 30333 (AKallen@cdc.gov)
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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.

Design.

Retrospective cohort and case-control study of all episodes of HO-CDI both before and after 2 interventions.

Setting.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 3 , March 2009 , pp. 264 - 272
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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