Emergence of Fluoroquinolones as the Predominant Risk Factor for Clostridium difficile-Associated Diarrhea: A Cohort Study during an Epidemic in Quebec

Pépin, Jacques; Saheb, Nathalie; Coulombe, Marie‐Andrée; Alary, Marie-Eve; Corriveau, Marie-Pier; Authier, Simon; Leblanc, M.; Rivard, Geneviève; Bettez, Mathieu; Primeau, Valérie; Nguyen, Martin; Jacob, Claude-Émilie; Lanthier, Luc

doi:10.1086/496986

Cited by 906 publications

(649 citation statements)

References 40 publications

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“…A virulent new strain of Clostridium difficile has caused severe disease and death in several locations in the U.S., Canada, the Netherlands, and the U.K. [42][43][44][45] The new strain is resistant to fluoroquinolones, and fluoroquinolone consumption is a risk factor for diarrhea. [43][44][45] It is an additional concern that the use of fluoroquinolones for prophylaxis may lead to outbreaks of the new strain of Clostridium difficile.…”

Section: Infections Caused By Clostridium Difficilementioning

confidence: 99%

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Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

174

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New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. For patients with acute leukemia or those who undergo bone marrow transplantation, prophylaxis with fluoroquinolones diminished the risk of death from any cause by 33% (95% confidence interval [95% CI], 2-54%). Thus, 55 patients who have acute leukemia or who undergo bone marrow transplantation must receive prophylaxis to prevent 1 death. In 4 studies that included patients with solid tumors or lymphoma, prophylaxis reduced the rate of death during the first month (relative risk, 0.51; 95% CI, 0.27-0.97), and 82 patients had to receive prophylaxis to prevent 1 death. The main argument brought against prophylaxis is the induction of resistance. Patients who received prophylaxis did not experience more infections caused by resistant strains than patients in the control group. The recent GIMEMA study was con- N ew evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. A systematic review and meta-analysis of randomized controlled trials 1 demonstrated that death from all causes was reduced by 34% (95% confidence interval [95% CI], 21-45%) in neutropenic patients who received any antibiotic prophylaxis and by 40% (95% CI, 17-56%) in patients who received quinolones for prophylaxis. in addition, the occurrence of febrile episodes and bacterial infections decreased significantly (Table 1). Most of the studies that were included in that meta-analysis addressed patients with hematologic malignancies. In the most recent and largest randomized controlled trial that included patients in whom neutropenia was expected to occur for more than 7 days (mainly with acute leukemia and autologous peripheral blood stem cell transplantation), 2 patients who received levofloxacin as prophylaxis had a relative risk (RR) of 0.54 (95% CI, 0.25-1.16) for mortality compared with the placebo group: a Dr. Cullen has received honoraria from Sanofi Aventis.We thank Dr. Vivianne Tjan-Heijnen and Ms. Muriel Debois for supplying us with full data regarding mortality from their study.

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Section: Infections Caused By Clostridium Difficilementioning

confidence: 99%

“…[43][44][45] It is an additional concern that the use of fluoroquinolones for prophylaxis may lead to outbreaks of the new strain of Clostridium difficile.…”

Section: Infections Caused By Clostridium Difficilementioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

174

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“…The contribution of antibiotics, particularly certain classes (cephalosporins, co-amoxiclav, clindamycin and quinolones), which we have termed 'C. diffogenic' agents (CDAs), to the current epidemic of CDI has been recognised from a variety of studies [13][14][15][16][17][18]. This information and evidence linking the high-level impact of antibiotic restriction combined with strict infection control measures in controlling hospital CDI outbreaks [19][20][21][22][23] supported the development and implementation of national guidance on restriction of CDA antibiotics.…”

Section: Infection Managementmentioning

confidence: 99%

“…Fluoroquinolones are antibiotics that are not recommended for use within primary care, except for a few specific infections, and their inappropriate use has been associated with an increased risk of CDI, particularly the 027 and 106 strains, both of which are prevalent in Scotland [13,15,33]. Excess usage of fluoroquinolones during the winter months suggests inappropriate use for respiratory infections.…”

Section: Primary Care Indicatorsmentioning

confidence: 99%

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme

Nathwani

Sneddon²,

Malcolm

et al. 2011

International Journal of Antimicrobial Agents

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“…3 There are additional concerns in that fluoroquinolones appear to be a significant risk factor in precipitating C. difficile infections caused by the hypervirulent 027 strain. 12 Although these data were largely based on ciprofloxacin use, it is likely that the newer fluoroquinolones will have a similar effect. Quinolones are not recommended for use in the under-18s except on the advice of a paediatrician or microbiologist.…”

Section: Quinolonesmentioning

confidence: 99%

Recommended management of lower respiratory tract infections

Meisner

2008

Prescriber

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L ower respiratory tract infections (LRTIs) cover a broad spectrum of pathological processes and aetiologies, including acute and chronic bronchitis, bronchiolitis and acute and chronic pneumonia, as well as pleural effusions, empyemas and lung abscesses.The latter three conditions will usually be managed in hospital initially, and treatment will depend on the microbiology. In complicated pneumonias, eg in immunosuppressed or HIV-infected individuals, and in chronic lung conditions such as cystic fibrosis, decisions on antibiotic therapy should be made by the specialist physician looking after the patient in conjunction with a microbiologist, virologist or infectious disease physician.This review concentrates on the LRTIs that are seen and managed by GPs. Appropriate patient selection for treatment and the correct use of agents are important, not only in optimising therapy for the individual patient but also in order to keep emergence of

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Emergence of Fluoroquinolones as the Predominant Risk Factor for Clostridium difficile-Associated Diarrhea: A Cohort Study during an Epidemic in Quebec

Abstract: Administration of fluoroquinolones emerged as the most important risk factor for CDAD in Quebec during an epidemic caused by a hypervirulent strain of C. difficile.

Cited by 906 publications

References 40 publications

Antibiotic prophylaxis in neutropenic patients

Antibiotic prophylaxis in neutropenic patients

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme

Recommended management of lower respiratory tract infections

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