Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of  Clostridium difficile  infections in a region of Scotland: a non-linear time-series analysis

Lawes, Timothy; López-Lozano, J.M.; Nebot, César; Macartney, Gillian; Subbarao-Sharma, Rashmi; Wares, Karen D; Sinclair, Carolyn; Gould, Ian M.

doi:10.1016/s1473-3099(16)30397-8

Cited by 114 publications

(71 citation statements)

References 27 publications

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“…To explore the specific reasons leading to CDI, this study set up a comparison between the HA-CDI group and the non-C. difficile AAD group in AAD patients to identify which antibiotics or predictors were associated with a high risk for HA-CDI. Although many risk factors were revealed in univariate analysis, only two independent risk factors, cephalosporin use prior to the onset of diarrhea and chronic kidney diseases were identified for patients with HA-CDI when compared to non-C.difficile AAD, which is consistent with previous reports [29][30][31] and not difficult to explain. In addition to the cephalosporins known to all [32], chronic renal disease may cause poor excretion of antibiotic agents, high concentration in blood and finally, the imbalance of bacterial flora in the gut.…”

Section: Discussionsupporting

confidence: 89%

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Dai

TianXiang²,

Yan

et al. 2020

BMC Infect Dis

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Background: Clostridium difficile infection (CDI), especially hospital-acquired Clostridium difficile infection (HA-CDI), continues to be a public health problem and has aroused great concern worldwide for years. This study aimed to elucidate the clinical and epidemiological features of HA-CDI and the characteristics of C.difficile isolates in Chongqing, Southwest China.Methods: A case-control study was performed to identify the clinical incidence and risk factors of HA-CDI. C. difficile isolates were characterised by polymerase chain reaction (PCR) ribotyping, multilocus sequence typing (MLST), toxin gene detection and antimicrobial susceptibility testing.Results: Of the 175 suspicious patients, a total of 122 patients with antibiotic-associated diarrhea (AAD) were included in the study; among them, 38 had HA-CDI. The incidence of AAD and HA-CDI was 0.58 and 0.18 per 1000 patient admissions, respectively. Chronic renal disease and cephalosporin use were independent risk factors for HA-CDI. Fifty-five strains were assigned into 16 sequence types (STs) and 15 ribotypes (RTs). ST2/RT449 (8, 14.5%) was the predominant genotype. Of the 38 toxigenic isolates, A + B + CDT-isolates accounted for most (34, 89.5%) and 1 A + B + CDT+ isolate emerged. No isolate was resistant to vancomycin, metronidazole or tigecycline, with A-B-CDTbeing more resistant than A + B + CDT-.Conclusions: Different genotypes of C. difficile strains were witnessed in Chongqing, which hinted at the necessary surveillance of HA-CDI. Adequate awareness of patients at high risk of HA-CDI acquisition is advocated and cautious adoption of cephalosporins should be highlighted.

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Section: Discussionsupporting

confidence: 89%

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Dai

TianXiang²,

Yan

et al. 2020

BMC Infect Dis

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“…6,7 In Scotland, a reduction in high-risk antibiotic use was associated with concomitant decreases in NAP1/027 and CDI incidence. 8 In contrast, a decrease of NAP1/027 was observed in the Netherlands, but there was no change in nationwide fluoroquinolone use. 9 Similarly, decreases in LTCF-onset CDI incidence and NAP1/027 in Monroe County, NY, preceded local efforts to reduce fluoroquinolone use, 10 suggesting that other factors might also be contributing, such as changes in infection prevention practices, LTCF antibiotic use, or natural changes in C difficile strain distribution.…”

Section: Discussionmentioning

confidence: 94%

Trends in incidence of long-term-care facility onset Clostridium difficile infections in 10 US geographic locations during 2011-2015

Guh

Baggs

et al. 2018

American Journal of Infection Control

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During 2011-2015, the adjusted long-term-care facility onset Clostridium difficile infection incidence rate in persons aged ≥65 years decreased annually by 17.45% (95% confidence interval, 14.53%-20.43%) across 10 US sites. A concomitant decline in inpatient fluoroquinolone use and the C difficile epidemic strain NAP1/027 among persons aged ≥65 years may have contributed to the decrease in long-term-care facility-onset C difficile infection incidence rate.

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“…3 Moreover, recent reports suggest that fluoroquinolone restriction may be effective as a control measure for C difficile infection (CDI), in part through reduction in infections due to fluoroquinolone-resistant C difficile strains. [3][4][5][6][7][8][9][10] In many of these studies, fluoroquinolone use was reduced through formulary restrictions or revised fluoroquinolone use guidelines, often over relatively short time periods and with resultant increases in use of other antibiotic classes.…”

mentioning

confidence: 99%

Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: An interrupted time series analysis

Hecker

Son

Murphy

et al. 2019

American Journal of Infection Control

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Background: Fluoroquinolones are often prescribed unnecessarily and are an important risk factor for infection with fluoroquinolone-resistant gram-negative bacilli and Clostridioides difficile. Methods: We conducted a quasi-experimental study to determine the impact of sequential syndrome-specific stewardship interventions on use of and resistance to fluoroquinolones in a tertiary care hospital. An initial 2-year intervention focused on reducing treatment of asymptomatic bacteriuria and ensuring concordance of urinary tract infection treatment with guidelines. A second 5-year intervention focused on limiting overuse of fluoroquinolones for health care−associated pneumonia in conjunction with a formal stewardship program. The primary outcomes were fluoroquinolone use and changes in use over time analyzed by segmented regression analysis. Results: The asymptomatic bacteriuria and urinary tract infection intervention resulted in a significant reduction in fluoroquinolone use, with a significant change from an increasing to a decreasing rate of use (change in slope of quarterly defined daily doses/1,000 patient days −15.3, P < .01). The health care−associated pneumonia intervention resulted in a continued significant reduction in fluoroquinolone use (rate ratio = 0.68, P < .01). During the interventions, fluoroquinolone susceptibility increased significantly in Pseudomonas aeruginosa, but not in Escherichia coli, Klebsiella spp., or C difficile. Conclusions: Antimicrobial stewardship interventions focused on specific syndromes may be effective in reducing fluoroquinolone use. In our hospital, reduction in fluoroquinolone use resulted in increased fluoroquinolone susceptibility in P aeruginosa, but not other Enterobacteriaceae or C difficile.

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Effect of a national 4C antibiotic stewardship intervention on the clinical and molecular epidemiology of Clostridium difficile infections in a region of Scotland: a non-linear time-series analysis

Cited by 114 publications

References 27 publications

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Characteristics of Clostridium difficile isolates and the burden of hospital-acquired Clostridium difficile infection in a tertiary teaching hospital in Chongqing, Southwest China

Trends in incidence of long-term-care facility onset Clostridium difficile infections in 10 US geographic locations during 2011-2015

Impact of syndrome-specific antimicrobial stewardship interventions on use of and resistance to fluoroquinolones: An interrupted time series analysis

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