Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection (CDI) with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain, BI/NAP1/027 Journal Article

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Authors: Wieczorkiewicz, J. T.; Lopansri, B. K.; Cheknis, A; Osmolski, J. R.; Hecht, D. W.; Gerding, D. N.; Johnson, S
Article Title: Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection (CDI) with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain, BI/NAP1/027
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 US 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 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 compared to non-BI controls (OR for fluoroquinolones; 3.2; 95% CI 1.3, 7.5; plt;0.001; OR for macrolides: 5.2; 95% CI 1.1, 24.0; p=0.04)). In contrast, clindamycin use was less frequent among the BI cases than the controls (OR 0.1; 95% CI 0.03, 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 and macrolide use and C. difficile resistance to these antibiotic classes were associated with infection by the epidemic BI strain of C. difficile in a US hospital during a time when CDI rates were increasing nationally due to the highly fluoroquinolone-resistant BI/NAP1/027 strain.
Journal Title: Antimicrobial Agents and Chemotherapy
ISSN: 1098-6596; 0066-4804
Publisher: American Society for Microbiology. All Rights Reserved  
Date Published: 2015
Language: ENG
DOI/URL:

AAC.01820-15
Notes: LR: 20151104; CI: Copyright (c) 2015; JID: 0315061; aheadofprint