Antibiotic prescribing policy and Clostridium difficile diarrhoea.

Hdl Handle:
http://hdl.handle.net/10147/208954
Title:
Antibiotic prescribing policy and Clostridium difficile diarrhoea.
Authors:
O'Connor, K A; Kingston, M; O'Donovan, M; Cryan, B; Twomey, C; O'Mahony, D
Affiliation:
South Munster Geriatric Training Scheme, Departments of Geriatric Medicine, Cork , University Hospital, Cork, and St. Finbarr's Hospital, Cork, Ireland.
Citation:
QJM. 2004 Jul;97(7):423-9.
Journal:
QJM : monthly journal of the Association of Physicians
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/208954
PubMed ID:
15208430
Abstract:
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.
Language:
eng
MeSH:
Aged; Anti-Bacterial Agents/*administration & dosage/adverse effects; Cephalosporins/administration & dosage/adverse effects; *Clostridium difficile; Cross Infection/chemically induced/*prevention & control; Diarrhea/chemically induced/microbiology/*prevention & control; Enterocolitis, Pseudomembranous/chemically induced/epidemiology/*prevention &; control; Female; Hospitalization; Humans; Incidence; Injections, Intravenous; Ireland/epidemiology; Male; Physician's Practice Patterns; Retrospective Studies
ISSN:
1460-2725 (Print); 1460-2393 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Connor, K Aen_GB
dc.contributor.authorKingston, Men_GB
dc.contributor.authorO'Donovan, Men_GB
dc.contributor.authorCryan, Ben_GB
dc.contributor.authorTwomey, Cen_GB
dc.contributor.authorO'Mahony, Den_GB
dc.date.accessioned2012-02-03T15:08:23Z-
dc.date.available2012-02-03T15:08:23Z-
dc.date.issued2012-02-03T15:08:23Z-
dc.identifier.citationQJM. 2004 Jul;97(7):423-9.en_GB
dc.identifier.issn1460-2725 (Print)en_GB
dc.identifier.issn1460-2393 (Linking)en_GB
dc.identifier.pmid15208430en_GB
dc.identifier.urihttp://hdl.handle.net/10147/208954-
dc.description.abstractBACKGROUND: 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.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAnti-Bacterial Agents/*administration & dosage/adverse effectsen_GB
dc.subject.meshCephalosporins/administration & dosage/adverse effectsen_GB
dc.subject.mesh*Clostridium difficileen_GB
dc.subject.meshCross Infection/chemically induced/*prevention & controlen_GB
dc.subject.meshDiarrhea/chemically induced/microbiology/*prevention & controlen_GB
dc.subject.meshEnterocolitis, Pseudomembranous/chemically induced/epidemiology/*prevention &en_GB
dc.subject.meshcontrolen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHospitalizationen_GB
dc.subject.meshHumansen_GB
dc.subject.meshIncidenceen_GB
dc.subject.meshInjections, Intravenousen_GB
dc.subject.meshIreland/epidemiologyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshPhysician's Practice Patternsen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.titleAntibiotic prescribing policy and Clostridium difficile diarrhoea.en_GB
dc.contributor.departmentSouth Munster Geriatric Training Scheme, Departments of Geriatric Medicine, Cork , University Hospital, Cork, and St. Finbarr's Hospital, Cork, Ireland.en_GB
dc.identifier.journalQJM : monthly journal of the Association of Physiciansen_GB
dc.description.provinceMunster-

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