JAC Advance Access published online on May 26, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh285
© 2004 by The British Society for Antimicrobial Chemotherapy
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Departments of Microbiology, Leeds Teaching Hospitals & University of Leeds, Old Medical School, Leeds LS1 3EX, UK
* To whom correspondence should be addressed. E-mail: Mark.Wilcox{at}leedsth.nhs.uk.
Objectives: We followed the effects of changes to a new antibiotic policy favouring a ureidopenicillin as opposed to a third-generation cephalosporin on the long-term incidence of Clostridium difficile diarrhoea (CDD) and antibiotic utilization in a large Elderly Medicine Unit. Patients and methods: In 1999, piperacillin-tazobactam was added to the formulary in Elderly Medicine and its use promoted in preference to cefotaxime. Following review and feedback to clinicians of surveillance data, cefotaxime prescribing was actively restricted during 2000-2001. An audit of prescriber adherence to antibiotic policy was carried out by reviewing the records of 159 patients during February-April 2001. In December 2001, due to manufacturer production problems, supply of piperacillin-tazobactam was stopped. We performed standardized period prevalence surveillance (February-April) allowing comparisons of antibiotic utilization and CDD incidence during the 5 year study period (1998-2002). Results: CDD incidence did not change significantly (P>0.1) during 1998-1999 despite a marked increase in piperacillin-tazobactam prescribing. However, when cefotaxime prescribing was curtailed in 2001, CDD rates decreased (in four of five wards) and overall by 52% (P=0.008). When piperacillin-tazobactam became unavailable in 2002, despite advice to the contrary cefotaxime prescribing rose five-fold, and CDD rates increased in four of five wards and by 232% (P<0.01) overall. Adherence to antibiotic policy introduced in 2000 was good (81% accordance); 94%, 88% and 73% of patients with cellulitis, urinary tract and respiratory tract infection, respectively, received appropriate antibiotics. Conclusions: Long-term prescribing of piperacillin-tazobactam in Elderly Medicine in preference to cefotaxime is associated with reduced rates of CDD. However, unless cephalosporin prescribing is curtailed, the beneficial effects on CDD rates may be missed. This is one of few studies to document adverse effects due to loss of antibiotic supply.
Revised April 16, 2004
Accepted April 18, 2004
Original article
Long-term surveillance of cefotaxime and piperacillin-tazobactam prescribing and incidence of Clostridium difficile diarrhoea
2 Elderly Medicine, Leeds Teaching Hospitals & University of Leeds, Old Medical School, Leeds LS1 3EX, UK
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  O. M. Williams and R. C. Spencer The management of Clostridium difficile infection Br. Med. Bull., September 1, 2009; 91(1): 87 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Gouliouris, D. R. Forsyth, and N. M. Brown Clostridium difficile-associated diarrhoea (CDAD): new and contentious issues Age Ageing, September 1, 2009; 38(5): 497 - 500. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Vernaz, K. Hill, S. Leggeat, D. Nathwani, G. Philips, P. Bonnabry, and P. Davey Temporal effects of antibiotic use and Clostridium difficile infections J. Antimicrob. Chemother., June 1, 2009; 63(6): 1272 - 1275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Yates, D M Murphy, A J Fisher, F K Gould, J L Lordan, J H Dark, and P A Corris Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation BMJ Case Reports, May 8, 2009; 2009(may08_1): bcr1120081218 - bcr1120081218. [Abstract] [Full Text]
|
|
|
|
 |
|
 T Monaghan, T Boswell, and Y R Mahida Recent advances in Clostridium difficile-associated disease Postgrad. Med. J., March 1, 2009; 85(1001): 152 - 162. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Imhoff and K. Karpa Is There a Future for Probiotics in Preventing Clostridium difficile-Associated Disease and Treatment of Recurrent Episodes? Nutr Clin Pract, February 1, 2009; 24(1): 15 - 32. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Monaghan, T Boswell, and Y R Mahida Recent advances in Clostridium difficile-associated disease Gut, June 1, 2008; 57(6): 850 - 860. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B Yates, D M Murphy, A J Fisher, F K Gould, J L Lordan, J H Dark, and P A Corris Pseudomembranous colitis in four patients with cystic fibrosis following lung transplantation Thorax, June 1, 2007; 62(6): 554 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Asha, D. Tompkins, and M. H. Wilcox Comparative Analysis of Prevalence, Risk Factors, and Molecular Epidemiology of Antibiotic-Associated Diarrhea Due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J. Clin. Microbiol., August 1, 2006; 44(8): 2785 - 2791. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Musher, N. Logan, V. Mehendiratta, R. E. Polk, M. Oinonen, A. Pakyz, M. H. Wilcox, J. Freeman, K. Iwata, A. Doi, et al. Epidemic Clostridium difficile. N. Engl. J. Med., March 16, 2006; 354(11): 1199 - 1203. [Full Text] [PDF]
|
|
|
|
 |
|
 C. MacDougall and R. E. Polk Antimicrobial Stewardship Programs in Health Care Systems Clin. Microbiol. Rev., October 1, 2005; 18(4): 638 - 656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Freeman, S. D. Baines, D. Jabes, and M. H. Wilcox Comparison of the efficacy of ramoplanin and vancomycin in both in vitro and in vivo models of clindamycin-induced Clostridium difficile infection J. Antimicrob. Chemother., October 1, 2005; 56(4): 717 - 725. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. J. Pultz and C. J. Donskey Effect of Antibiotic Treatment on Growth of and Toxin Production by Clostridium difficile in the Cecal Contents of Mice Antimicrob. Agents Chemother., August 1, 2005; 49(8): 3529 - 3532. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Baines, J. Freeman, and M. H. Wilcox Effects of piperacillin/tazobactam on Clostridium difficile growth and toxin production in a human gut model J. Antimicrob. Chemother., June 1, 2005; 55(6): 974 - 982. [Abstract] [Full Text] [PDF]
|
|