Increased Incidence of Clostridium difficile-Associated Diarrhea Following Decreased Restriction of Antibiotic Use

Removal of antimicrobial agents from formulary restriction status at our center was followed by an increase in the incidence of Clostridium difficile-associated diarrhea. The mean monthly incidence of C. difficile diarrhea for the 12-month period before institution of decreased restriction of antibi...

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Bibliographic Details
Published in:Clinical infectious diseases 1996-12, Vol.23 (Supplement-1), p.S102-S106
Main Authors: Ho, Macy, Yang, Debbie, Wyle, Frederic A., Mulligan, Maury Ellis
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - adverse effects
Antibiotics
Antimicrobials
Bacterial diseases
Bacterial diseases of the digestive system and abdomen
Biological and medical sciences
California - epidemiology
Clostridium
Clostridium difficile
Clostridium difficile - pathogenicity
Colitis
Diarrhea
Diarrhea - epidemiology
Diarrhea - microbiology
Enterocolitis, Pseudomembranous - epidemiology
Enterocolitis, Pseudomembranous - microbiology
Epidemiology
Formularies, Hospital as Topic
Human bacterial diseases
Humans
Infections
Infectious diseases
Medical sciences
Middle Aged
Predisposing factors
Retrospective Studies
Toxins
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Summary:Removal of antimicrobial agents from formulary restriction status at our center was followed by an increase in the incidence of Clostridium difficile-associated diarrhea. The mean monthly incidence of C. difficile diarrhea for the 12-month period before institution of decreased restriction of antibiotic use was 3.4 infections per 1,000 admissions and rose to 6.2 infections per 1,000 admissions during the following 4-month period (P < .05). Patients who developed disease before and after decreased restriction of antibiotics were similar in terms of the mean number of antimicrobial agents administered and mean duration of therapy. The most commonly administered agents whose use preceded the onset of disease were cefazolin, trimethoprim-sulfamethoxazole, ampicillin, ticarcillin/clavulanate, and gentamicin (the latter drug was always used in combination with other agents). Immunoblot typing indicated that there was no association between C. difficile strains and administration of specific agents. There was no coincidental epidemic to account for the increased incidence of infection. The increased incidence of C. difficile disease is a potential problem that may occur following removal of extended-spectrum antimicrobial agents from formulary restriction status.
ISSN:1058-4838
1537-6591
DOI:10.1093/clinids/23.Supplement_1.S102