Evidence grows that reducing fluroquinolone use can control C. difficile
Study data from 55 Veterans’ Affairs hospitals showed that facility-level fluroquinolone use was a significant predictor of nosocomial Clostridioides difficile infections, researchers reported in Infection Control & Hospital Epidemiology.
The findings “build upon a growing body of evidence supporting reductions in use of fluoroquinolones as a control measure for [C. difficile infection (CDI)], particularly in settings where ribotype 027 or other fluoroquinolone-resistant strains are common,” the researchers wrote.
“In the United States and England, there has been a decrease in health care-associated C. difficile infections (HCA CDIs) and in the percentage of infections due to epidemic fluoroquinolone-resistant ribotype 027 strains. It is not clear if these changes in the epidemiology of C. difficile can be attributed to reductions in use of fluoroquinolones,” Curtis J. Donskey, MD, professor of medicine at Case Western University and staff infectious disease physician at the Louis Stokes Cleveland VA Medical Center, told Healio
According to Donskey, in many VA facilities, C. difficile testing includes identification of ribotype 027 strains.
“This provided a great opportunity to assess whether facility-level fluoroquinolone use predicts HCA CDI due to fluoroquinolone-resistant strains,” he said.
In their study, Donskey and colleagues assessed a nationwide cohort of hospitalized patients in the VA health care system. According to the study, they identified hospitals that categorized more than 80% of CDI cases as positive or negative for the 027 strain for at least one-quarter of the 2011 to 2018 fiscal years. They then used visual summaries and multilevel logistic regression models to assess the association between facility-level fluoroquinolone use and facility-associated CDI rates due to 027 strains.
According to the study, between 2011 and 2018, 55 hospitals met the criteria for reporting 027 results. Among a total of 5,091 facility-associated CDI cases, 20% were attributable to 027 strains. The study demonstrated that the use of fluoroquinolones decreased by 52% between 2011 and 2018, as did the overall rates of facility-associated CDI (13%) and the proportion of these cases caused by the 027 strain (55%).
“Reducing use of fluoroquinolones may be useful as a control measure for CDI in settings where fluoroquinolone use is high and fluoroquinolone-resistant strains are common,” Donskey said.
In the paper, Donskey and colleagues said a randomized control trial could provide additional evidence to support this.