Q J Med 2004; 97: 423-429
QJM vol. 97 no. 7 © Association of Physicians 2004; all rights reserved.
Antibiotic prescribing policy and Clostridium difficile diarrhoea
From the South Munster Geriatric Training Scheme, Departments of Geriatric Medicine and 1Microbiology, Cork University Hospital, Cork, and St. Finbarr's Hospital, Cork, Ireland
Received 13 January 2004 and in revised form 17 March 2004
Background: Broad-spectrum antibiotics, particularly intravenous cephalosporins, are associated with Clostridium difficile diarrhoea. Diarrhoea due to C. difficile is a growing problem in hospitals, especially among elderly patients.
Aim: To establish whether changing an antibiotic policy with the aim of reducing the use of injectable cephalosporins leads to a reduction in the incidence of C. difficile diarrhoea in elderly patients.
Design: Retrospective analysis.
Methods: A group of patients who were subject to the new antibiotic policy from the period following July 2000, were compared with patients who were admitted prior to July 2000 and were not subject to the new policy. Infections, antibiotic prescriptions and mortality rates were determined from case notes, and C. difficle diarrhoea rates from microbiological data.
Results: Intravenous cephalosporin use fell from 210 to 28 defined daily doses (p < 0.001) following the change in antibiotic policy, with a corresponding increase in piperacillin-tazobactam (p < 0.001) and moxifloxacin (p < 0.001) use. The new policy led to a significant reduction in C. difficile diarrhoea cases. The relative risk of developing C. difficile infection with the old policy compared to the new policy was 3.24 (95%CI 1.07–9.84, p = 0.03).
Discussion: The antibiotic policy was successfully introduced into an elderly care service. It reduced both intravenous cephalosporin use and C. difficile diarrhoea.
Address correspondence to: Dr D. O’ Mahony, Department of Geriatric Medicine, Cork University Hospital, Wilton, Cork, Ireland. e-mail: omahonyd{at}shb.ie
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T Monaghan, T Boswell, and Y R Mahida Recent advances in Clostridium difficile-associated disease Postgrad. Med. J., March 1, 2009; 85(1001): 152 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Imhoff and K. Karpa Is There a Future for Probiotics in Preventing Clostridium difficile-Associated Disease and Treatment of Recurrent Episodes? Nutr Clin Pract, February 1, 2009; 24(1): 15 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. I. I. van der Kooi, M. Koningstein, A. Lindemans, D. W. Notermans, E. Kuijper, R. van den Berg, H. Boshuizen, P. M. G. Filius, and S. van den Hof Antibiotic use and other risk factors at hospital level for outbreaks with Clostridium difficile PCR ribotype 027 J. Med. Microbiol., June 1, 2008; 57(6): 709 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Monaghan, T Boswell, and Y R Mahida Recent advances in Clostridium difficile-associated disease Gut, June 1, 2008; 57(6): 850 - 860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Baines, J. Freeman, and M. H. Wilcox Effects of piperacillin/tazobactam on Clostridium difficile growth and toxin production in a human gut model J. Antimicrob. Chemother., June 1, 2005; 55(6): 974 - 982. [Abstract] [Full Text] [PDF]
|
|