Clinical and Translational Science Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
Infect Control Hosp Epidemiol. 2021 Jan;42(1):57-62. doi: 10.1017/ice.2020.383. Epub 2020 Sep 23.
Reduction in the use of fluoroquinolone antibiotics has been associated with reductions in Clostridioides difficile infections (CDIs) due to fluoroquinolone-resistant strains.
To determine whether facility-level fluoroquinolone use predicts healthcare facility-associated (HCFA) CDI due to fluoroquinolone-resistant 027 strains.
Using a nationwide cohort of hospitalized patients in the Veterans' Affairs Healthcare System, we identified hospitals that categorized >80% of CDI cases as positive or negative for the 027 strain for at least one-quarter of fiscal years 2011-2018. Within these facilities, we used visual summaries and multilevel logistic regression models to assess the association between facility-level fluoroquinolone use and rates of HCFA-CDI due to 027 strains, controlling for time and facility complexity level, and adjusting for correlated outcomes within facilities.
Between 2011 and 2018, 55 hospitals met criteria for reporting 027 results, including a total of 5,091 HCFA-CDI cases, with 1,017 infections (20.0%) due to 027 strains. Across these facilities, the use of fluoroquinolones decreased by 52% from 2011 to 2018, with concurrent reductions in the overall HCFA-CDI rate and the proportion of HCFA-CDI cases due to the 027 strain of 13% and 55%, respectively. A multilevel logistic model demonstrated a significant effect of facility-level fluoroquinolone use on the proportion of infections in the facility due to the 027 strain, most noticeably in low-complexity facilities.
Our findings provide support for interventions to reduce use of fluroquinolones as a control measure for CDI, particularly in settings where fluoroquinolone use is high and fluoroquinolone-resistant strains are common causes of infection.
由于氟喹诺酮类耐药菌株的存在，氟喹诺酮类抗生素的使用减少与艰难梭菌感染（CDI）的减少有关。
确定医疗机构层面氟喹诺酮类药物的使用是否可预测由氟喹诺酮类耐药 027 株引起的医疗机构相关（HCFA）CDI。
利用退伍军人事务部医疗保健系统中住院患者的全国性队列，我们确定了在 2011 年至 2018 年的至少一个财年中，将超过 80%的 CDI 病例归类为 027 株阳性或阴性的医院。在这些医疗机构中，我们使用直观摘要和多水平逻辑回归模型，评估了医疗机构层面氟喹诺酮类药物使用与由 027 株引起的 HCFA-CDI 发生率之间的关联，同时控制时间和医疗机构复杂程度，并调整医疗机构内相关结局。
2011 年至 2018 年期间，有 55 家医院符合报告 027 结果的标准，共报告了 5091 例 HCFA-CDI 病例，其中 1017 例（20.0%）感染为 027 株。在这些医疗机构中，氟喹诺酮类药物的使用从 2011 年到 2018 年下降了 52%，同时，总体 HCFA-CDI 发生率和由 027 株引起的 HCFA-CDI 病例比例分别下降了 13%和 55%。多水平逻辑模型显示，医疗机构层面氟喹诺酮类药物使用对医疗机构中由 027 株引起的感染比例有显著影响，在低复杂度医疗机构中最为明显。
我们的研究结果为减少氟喹诺酮类药物的使用作为 CDI 的控制措施提供了支持，特别是在氟喹诺酮类药物使用量高且氟喹诺酮类耐药菌株是感染主要原因的环境中。
