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    Antibiotic prescribing policy and Clostridium difficile diarrhoea.

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    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.
    Issue Date
    2012-02-03T15:08:23Z
    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
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    Citation
    QJM. 2004 Jul;97(7):423-9.
    Journal
    QJM : monthly journal of the Association of Physicians
    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
    ISSN
    1460-2725 (Print)
    1460-2393 (Linking)
    Collections
    Cork University Hospital

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