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- Title
Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost.
- Authors
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
- Abstract
<bold>Background: </bold>Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.<bold>Objective: </bold>To characterize the impact of hospital-wide clindamycin restriction on the incidence of Clostridium difficile-associated diarrhea and on antimicrobial prescribing practices.<bold>Design: </bold>Prospective, observational cohort study.<bold>Setting: </bold>University-affiliated Veterans Affairs Medical Center.<bold>Patients: </bold>Hospitalized patients with symptomatic diarrhea.<bold>Measurements: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Publication
Annals of Internal Medicine, 1998, Vol 128, Issue 12, p989
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-128-12_part_1-199806150-00005