Climo M W, Israel D S, Wong E S, Williams D, Coudron P, Markowitz S M
Hunter Holmes McGuire Veterans Affairs Medical Center, Medical College of Virginia, and Virginia Commonwealth University, Richmond 23249, USA.
Ann Intern Med. 1998 Jun 15;128(12 Pt 1):989-95. doi: 10.7326/0003-4819-128-12_part_1-199806150-00005.
Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.
To characterize the impact of hospital-wide clindamycin restriction on the incidence of Clostridium difficile-associated diarrhea and on antimicrobial prescribing practices.
Prospective, observational cohort study.
University-affiliated Veterans Affairs Medical Center.
Hospitalized patients with symptomatic diarrhea.
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.
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.
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.
广泛使用抗生素与细菌耐药性增加和医院感染有关。
描述全院限制使用克林霉素对艰难梭菌相关性腹泻发病率及抗菌药物处方行为的影响。
前瞻性观察性队列研究。
大学附属退伍军人事务医疗中心。
有症状性腹泻的住院患者。
从医院药房记录中获取个体患者的临床数据和抗生素使用数据。监测全院抗菌药物的使用情况。对艰难梭菌分离株进行药敏试验和分子分型。
一次艰难梭菌相关性腹泻暴发由一株克林霉素耐药的艰难梭菌克隆株引起，且与克林霉素使用增加有关。全院要求使用克林霉素需经感染病会诊医生批准，导致克林霉素总体使用量减少，艰难梭菌相关性腹泻平均病例数持续减少（从每月11.5例降至每月3.33例；P<0.001），艰难梭菌分离株对克林霉素的敏感性增加（从9%增至61%；P<0.001）。同时，包括头孢替坦、替卡西林-克拉维酸和亚胺培南-西司他丁在内的其他具有抗厌氧活性的抗生素的使用量及其相关费用也出现了平行增加。由于艰难梭菌相关性腹泻发病率降低，医院实现了总体成本节约。
医院对克林霉素的处方限制是减少艰难梭菌感染数量的有效方法。它还可使分离株对克林霉素恢复敏感性，并可为医院节省成本。
