C diff and quinolones

3 Nov
2005

Fluoroquinolones Tied to C. difficile Diarrhea

The use of fluoroquinolone antibiotics appears to be the predominant risk factor for Clostridium difficile-associated diarrhea (CDAD), Canadian researchers report.

“The results of this cohort study delineate potential opportunities for intervention for hospitals dealing with epidemics caused by the hypervirulent strain of C. difficile,” lead investigator Dr. Jacques Pepin told Reuters Health.

“Reductions in incidence of C. difficile colitis can be achieved,” he added, “by avoiding as much as possible the high-risk antibiotics — fluoroquinolones –when treating common infections in the hospital setting and using low-risk antibiotics — aminoglycosides, cotrimoxazole — when this is possible.”

Wow! Quinolones are probably the mainstay antibiotic class at our hospital. We do see some c diff, but it does not seem like an epidemic.

Dr. Pepin and colleagues at the University of Sherbrooke in Quebec note that since the end of 2002 many hospitals in Quebec have been struggling with an epidemic of CDAD. In fact, there were more than 7000 cases of nosocomial CDAD reported in 2003.

To investigate associated factors, the researchers conducted a retrospective cohort study of 5619 hospital patients treated over an 18-month period. They were followed until they developed CDAD, died, or for 60 days after discharge.

In all, 293 developed CDAD and fluoroquinolones were the antibiotics most commonly associated with the condition (adjusted hazard ratio, 3.44), the investigators report in the November 1st issue of Clinical Infectious Diseases. Cephalosporins, macrolides, clindamycin and other antibiotics carried an intermediate risk with adjusted hazard ratios of 1.56 to 1.89.

The researchers speculated that proton pump inhibitors might also be implicated, but no such association was found.

Dr. Pepin’s group concludes that control of CDAD requires “a reduction in the use of fluoroquinolones and of intermediate-risk antibiotics and shorter duration of therapy for common infections.”

I will have to follow this story. Hopefully I can get some input from an ID type or some of the hospitalist readers. It is hard to fight data.

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Related posts:

  1. Public service announcement – beware of C diff
  2. More on C Diff
  3. Fluoroquinolones and tendon ruptures
  4. PPIs add risk for C Diff
  5. Antibiotics for strep throat?

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11 Responses to C diff and quinolones

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Todd

November 13th, 2005 at 11:21 pm

google search Cleveland and C. Diff, we’re having an outbreak of a stronger strain

Avatar

BUBBLES HESS

November 15th, 2005 at 7:17 pm

MY 6 MONTH OLD SON HAS C DIFF WHAT R SOME THINGS I CAN DO TO GET RID OF IT.HELP STOP IT FROM SPREADING TO OTHERS.KEEEP THING IN THE HOUSE FREE FROM THIS .HOW CAN I HELP HIM COAP OR FEEL BETTER BECAUSE HES JUST NOT HIMSELF .HE USEALLY IS LAUGHING AND SMILING BUT EVER SINCE HE CAUGHT THIS FROM A BOY IN THE NURSERY AT CHURCH HE JUST HASNT BEEN HIMSELF .PLEASE E-MAIL ME AT bubbles3915@yahooh.com thanks again i really appreciate it,
bubbles hess.

Avatar

GMM

November 22nd, 2005 at 10:53 pm

After suffering a nasty a** case of C Diff last year from antiobiotics after surgery , and having occasional flareups of the horrible kind, I have a dilemma. Do I get a sebbaceous cyst excised that has reappeared and go on antibiotics again- broad spectrum of course; or do I scream and yell and beg for a needle that takes out the gunge and finds out what will kill what is in it; or do I just wait for it to burst again????? I have no desire to deal with a cure that was nastier than the disease. EVER AGAIN! I am now friends with lacto bacillus acidophilus, Cold FX, yoghurt and kimchee, and brewer’s yeast on one occasion, because going on Flagyl and Vancomycin seemed like even more of a chance to take. I guess one of the comments I have is that if these diseases are out there, and there is no risk warning, and one almost DIES from an hospital acquired infection, then brings it home and possibly infects her family, who is responsible? And as a patient, why should I EVER believe in drugs again before a culture is done? Part of the problem as I see it, is that back when I was a kid in the 80’s, my family doctor took a swab, got it cultured and tested, AND THEN prescribed. Now, even though there is a push on to convince people they don’t need antibiotics in an ordinary situation, doctors don’t seem to have the ability to get testing done, to possibly further reduce the misuse of antibiotics. People like me are now not happy with regular medicine, and quite frankly, would rather go with unproven yoghurt and kimchee, than take a chance on death once again, because we cannot request the steps we think are necessary to protect our health. Kind of like your blogs on alternative medicine, and self prescribing ………Is there a happy medium, or is this partially because doctors and patients have an inherent mistrust between them these days, due to what has been happening with pharma, MRSA’s and no time to make a connection? I spend more time talking with my vet about putting down an animal than I do my doctor regarding surgery and its risks. And apparently (according to the nurse) I am lucky because she spends five minutes with me, and jokes around to boot—something she doesn’t normally do.

Maybe you can address some of the issues regarding how patients feel when thee is not time to explain. How do doctors feel about the time crunch?

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J with C Diff

December 2nd, 2005 at 8:04 am

I just was diagnosed with C Diff. I was on Omnicef a Cephalosporin antibiotic for a sinus infection. The doctor’s office was so busy I saw a nurse(one who has Alzheimers and concurrent problems with controlling bowel movements) came to visit. The two (antibiotic and elderly) are virulent mix.

I am also on yogurt as well as Flagyl and things seem to be clearing up a bit. I don’t blame the nurse practitioner because she was just trying to help my sinus infection but this is really a worry to me. I have missed nearly a week of work and from what I read this can be a chronic illness now!

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Joyce Gericke

December 5th, 2005 at 11:48 am

I was on Omnicef for about 2 weeks for an upper respitory infection, and was just diagnosd with C Dif. This is not fun! At least we caught it. I suffered unknowingly for 5 days. Is this a chronic thing subject to return?

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Mary Boehm

December 5th, 2005 at 5:36 pm

My mother has just been diagnosed with C-Diff. She has been suffering on an off for six months. But was recently hospitalized for 12 days while they tried to figure out what was wrong with her. She still remains week and has no appitie. She still also suffers from the diarhea. What is the prognosis from this disease. I just saw a new report about it on TV and the lady said she cries everyday wondering if she will ever ger better. What is the best way to help her and not be infected my self.

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nancy o'brien

December 6th, 2005 at 12:14 pm

My mother who is in a nursing home was just diagnosed with c-diff. She had been on septra or something like that for an upper respitory infection about 14 days prior to this diagnosis. In the meantime I took her out for Thanksgiving dinner, helped her in the bathroom, etc. I always kiss her good-bye when I leave. How infectious is this, should I be warning the others that were at the dinner and should I be calling my doctor for some preventive medicine? How long before any signs show up?

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Tom

May 1st, 2006 at 5:59 am

My father came down with c-diff October, 05. The hospitial & doctors didn’t make family members aware, so now my mother & I live in fear of taking antibiotics for as long as 20 months (which is what I now understand the spores can remain alive). My father was in the hospitial on 2 seperate occations before I figured out what the problem was, and only then did the doctors here admit it. He (my father) is now in a nursing home, and like the hospitial he wasn’t seperated from others, and now two more people living there have come down with it who’ve had contact with him. Untill doctors begin to inform patients & family members this will continue to spread.
Also during this time, my mother was in the hospitial where they did x-rays and found what they thought could be cancer in her chest. After other tests it was found not to be. The doctors office called in a script for a wide spectrum antibiotic even tho’ she showed no problems. When she refused to take them, and asked what she had to require them she was never given an answer. It’s been 3 months, and we assume it could be something as simple as scare tissue from pnuemonia or sugery from years ago. The State has now placed leans on our property due to it’s cost recovery programs for money paid for my fathers nursing home expenses. As others ask, Who IS responsible when it seems negligent on the part of the hospitial & doctors to begin with. To be honest, I’m quiet upset with the entire manner its be handled!

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JENNY OLIVE

January 27th, 2007 at 8:14 pm

MY MOTHER HAS C-DIFF , MY SISTER AN I ARE JUST WORN OUT, SHE WILL GET WELL AND THEN SHE IS SICK AGAIN. WE ARE TAKING CARE OF HER AT HER HOUSE SO THAT WE DO NOT SPREAD THIS TO OUR FAMILIES. WE ARE WORRIED THAT SHE WILL NOT GET BETTER. SHE IS DRINKING BUTTER MILK,YOUGART, ANYTHING WITH ACIDADAFALUS. JENNY

Avatar

Patricia Moerdyke

October 27th, 2007 at 5:18 am

What a nightmare I’ve been through since July 5, 2007! Had a tooth pulled, Dentist put me on amoxociline (sp?) 4 days later went to hospital for simple outpatient procedure. Contracted C-diff which I had never heard of. Thought I had the flu, and 3 days later called an ambulance. More medical expenses. Was put on antibiotic. Didn’t realize I needed to refill the prescription so only took it for 1 week instead of 2 weeks. The bacteria was still in me and I then had to go on Flagyl for 6 weeks. Started taking S. Boulardii at about the 4th week. A few days later, my feet started going numb. Thought it was from the S. Boulardii, so stopped taking it. Continued the Flagyl for 2 more weeks. Then read on the web that the numbness can be a side effect of Flagyl!! Went back to the emergency room once, went to a GP, went to my chiropractor, read much on the internet. Now after stopping Flagyl, one week later the bacteria is back and I’m having diarrhea again. Don’t know what step I’ll take next. Have ordered an infra-red laser machine to treat my numb feet, am taking Neurosil for that also. Probably vancomicin. Patricia

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