Michael W. Climo, MD; Debra S. Israel, PharmD; Edward S. Wong, MD; Denise Williams; Philip Coudron, PhD; Sheldon M. Markowitz, MD
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.
Climo MW, Israel DS, Wong ES, Williams D, Coudron P, Markowitz SM. Hospital-wide Restriction of Clindamycin: Effect on the Incidence of Clostridium difficile-Associated Diarrhea and Cost. Ann Intern Med. ;128:989–995. doi: 10.7326/0003-4819-128-12_Part_1-199806150-00005
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Published: Ann Intern Med. 1998;128(12_Part_1):989-995.
Hospital Medicine, Infectious Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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