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Epidemiology and Surveillance

Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI/NAP1/027

Jeffrey T. Wieczorkiewicz, Bert K. Lopansri, Adam Cheknis, James R. Osmolski, David W. Hecht, Dale N. Gerding, Stuart Johnson
Jeffrey T. Wieczorkiewicz
aHines VA Hospital, Hines, Illinois, USA
bMidwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA
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Bert K. Lopansri
cIntermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA
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Adam Cheknis
aHines VA Hospital, Hines, Illinois, USA
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James R. Osmolski
dLoyola University Medical Center, Maywood, Illinois, USA
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David W. Hecht
aHines VA Hospital, Hines, Illinois, USA
dLoyola University Medical Center, Maywood, Illinois, USA
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Dale N. Gerding
aHines VA Hospital, Hines, Illinois, USA
dLoyola University Medical Center, Maywood, Illinois, USA
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Stuart Johnson
aHines VA Hospital, Hines, Illinois, USA
dLoyola University Medical Center, Maywood, Illinois, USA
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DOI: 10.1128/AAC.01820-15
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ABSTRACT

Antibiotics have been shown to influence the risk of infection with specific Clostridium difficile strains as well as the risk of C. difficile infection (CDI). We performed a retrospective case-control study of patients infected with the epidemic BI/NAP1/027 strain in a U.S. hospital following recognition of increased CDI severity and culture of stools positive by C. difficile toxin immunoassay. Between 2005 and 2007, 72% (103/143) of patients with first-episode CDIs were infected with the BI strain by restriction endonuclease analysis (REA) typing. Most patients received multiple antibiotics within 6 weeks of CDI onset (median of 3 antibiotic classes). By multivariate analysis, fluoroquinolone and macrolide exposure was more frequent among BI cases than among non-BI-infected controls (odds ratio [OR] for fluoroquinolones, 3.2; 95% confidence interval [CI], 1.3 to 7.5; (P < 0.001; OR for macrolides, 5.2; 95% CI, 1.1 to 24.0; P = 0.04)). In contrast, clindamycin use was less frequent among the BI cases than among the controls (OR, 0.1; 95% CI, 0.03 to 0.4; P = 0.001). High-level resistance to moxifloxacin and azithromycin was more frequent among BI strains (moxifloxacin, 49/102 [48%] BI versus 0/40 non-BI, P = 0.0001; azithromycin, 100/102 [98%] BI versus 22/40 [55%] non-BI, P = 0.0001). High-level resistance to clindamycin was more frequent among non-BI strains (22/40 [55%] non-BI versus 7/102 [7%] BI, P = 0.0001). Fluoroquinolone use, macrolide use, and C. difficile resistance to these antibiotic classes were associated with infection by the epidemic BI strain of C. difficile in a U.S. hospital during a time when CDI rates were increasing nationally due to the highly fluoroquinolone-resistant BI/NAP1/027 strain.

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Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI/NAP1/027
Jeffrey T. Wieczorkiewicz, Bert K. Lopansri, Adam Cheknis, James R. Osmolski, David W. Hecht, Dale N. Gerding, Stuart Johnson
Antimicrobial Agents and Chemotherapy Dec 2015, 60 (1) 418-423; DOI: 10.1128/AAC.01820-15

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Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI/NAP1/027
Jeffrey T. Wieczorkiewicz, Bert K. Lopansri, Adam Cheknis, James R. Osmolski, David W. Hecht, Dale N. Gerding, Stuart Johnson
Antimicrobial Agents and Chemotherapy Dec 2015, 60 (1) 418-423; DOI: 10.1128/AAC.01820-15
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