| Autor: |
Climo MW, Israel DS, Wong ES, Williams D, Coudron P, Markowitz SM, Climo, M W, Israel, D S, Wong, E S, Williams, D, Coudron, P, Markowitz, S M |
| Zdroj: |
Annals of Internal Medicine; 06/15/98 Part 1 of 2, Vol. 128 Issue 12, p989-995, 7p |
| Abstrakt: |
Background: Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.Objective: To characterize the impact of hospital-wide clindamycin restriction on the incidence of Clostridium difficile-associated diarrhea and on antimicrobial prescribing practices.Design: Prospective, observational cohort study.Setting: University-affiliated Veterans Affairs Medical Center.Patients: Hospitalized patients with symptomatic diarrhea.Measurements: Clinical data on individual patients and data on antibiotic use were obtained from hospital pharmacy records. Hospital-wide use of antimicrobial agents was monitored. Isolates of C. difficile underwent antimicrobial susceptibility testing and molecular typing.Results: An outbreak of C. difficile-associated diarrhea was caused by a clonal isolate of clindamycin-resistant C. difficile and was associated with increased use of clindamycin. Hospital-wide requirement of approval by an infectious disease consultant of clindamycin use led to an overall reduction in clindamycin use, a sustained reduction in the mean number of cases of C. difficile-associated diarrhea (11.5 cases/month compared with 3.33 cases/month; P < 0.001), and an increase in clindamycin susceptibility among C. difficile isolates (9% compared with 61%; P < 0.001). A parallel increase was noted in the use of and costs associated with other antibiotics with antianaerobic activity, including cefotetan, ticarcillin-clavulanate, and imipenem-cilastin. The hospital realized overall cost savings as a result of the decreased incidence of C. difficile-associated diarrhea.Conclusions: Hospital formulary restriction of clindamycin is an effective way to decrease the number of infections due to C. difficile. It can also lead to a return in clindamycin susceptibility among isolates and can effect cost savings to the hospital. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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