{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:45:15Z","timestamp":1791283515724,"version":"4.1.0"},"reference-count":23,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X20003839_as1\"><jats:title>Background:<\/jats:title><jats:p>Reduction in the use of fluoroquinolone antibiotics has been associated with reductions in <jats:italic>Clostridioides difficile<\/jats:italic> infections (CDIs) due to fluoroquinolone-resistant strains.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20003839_as2\"><jats:title>Objective:<\/jats:title><jats:p>To determine whether facility-level fluoroquinolone use predicts healthcare facility-associated (HCFA) CDI due to fluoroquinolone-resistant 027 strains.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20003839_as3\"><jats:title>Methods:<\/jats:title><jats:p>Using a nationwide cohort of hospitalized patients in the Veterans\u2019 Affairs Healthcare System, we identified hospitals that categorized &gt;80% of CDI cases as positive or negative for the 027 strain for at least one-quarter of fiscal years 2011\u20132018. Within these facilities, we used visual summaries and multilevel logistic regression models to assess the association between facility-level fluoroquinolone use and rates of HCFA-CDI due to 027 strains, controlling for time and facility complexity level, and adjusting for correlated outcomes within facilities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20003839_as4\"><jats:title>Results:<\/jats:title><jats:p>Between 2011 and 2018, 55 hospitals met criteria for reporting 027 results, including a total of 5,091 HCFA-CDI cases, with 1,017 infections (20.0%) due to 027 strains. Across these facilities, the use of fluoroquinolones decreased by 52% from 2011 to 2018, with concurrent reductions in the overall HCFA-CDI rate and the proportion of HCFA-CDI cases due to the 027 strain of 13% and 55%, respectively. A multilevel logistic model demonstrated a significant effect of facility-level fluoroquinolone use on the proportion of infections in the facility due to the 027 strain, most noticeably in low-complexity facilities.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X20003839_as5\"><jats:title>Conclusions:<\/jats:title><jats:p>Our findings provide support for interventions to reduce use of fluroquinolones as a control measure for CDI, particularly in settings where fluoroquinolone use is high and fluoroquinolone-resistant strains are common causes of infection.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2020.383","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T04:19:00Z","timestamp":1600834740000},"page":"57-62","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":9,"title":["Inpatient fluoroquinolone use in Veterans\u2019 Affairs hospitals is a predictor of <i>Clostridioides difficile<\/i> infection due to fluoroquinolone-resistant ribotype 027 strains"],"prefix":"10.1017","volume":"42","author":[{"given":"Sandra Y.","family":"Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid M.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Redmond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis J.","family":"Donskey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"key":"S0899823X20003839_ref1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051590"},{"key":"S0899823X20003839_ref7","doi-asserted-by":"publisher","DOI":"10.1086\/522654"},{"key":"S0899823X20003839_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis614"},{"key":"S0899823X20003839_ref13","doi-asserted-by":"publisher","DOI":"10.1086\/605638"},{"key":"S0899823X20003839_ref19","volume-title":"2005","author":"Szabo"},{"key":"S0899823X20003839_ref14","doi-asserted-by":"publisher","DOI":"10.2807\/ese.14.45.19402-en"},{"key":"S0899823X20003839_ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408913"},{"key":"S0899823X20003839_ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2017.11.011"},{"key":"S0899823X20003839_ref5","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01582-06"},{"key":"S0899823X20003839_ref8","doi-asserted-by":"publisher","DOI":"10.1086\/595694"},{"key":"S0899823X20003839_ref21","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkv338"},{"key":"S0899823X20003839_ref2","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2478"},{"key":"S0899823X20003839_ref20","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2016.27"},{"key":"S0899823X20003839_ref15","volume":"63","author":"Thorpe","year":"2013\u20132016","journal-title":"Antimicrob Agents Chemother 2019"},{"key":"S0899823X20003839_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30514-X"},{"key":"S0899823X20003839_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30052-X"},{"key":"S0899823X20003839_ref3","doi-asserted-by":"publisher","DOI":"10.1086\/521859"},{"key":"S0899823X20003839_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(16)30397-8"},{"key":"S0899823X20003839_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30186-X"},{"key":"S0899823X20003839_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2015.05.013"},{"key":"S0899823X20003839_ref17","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy149"},{"key":"S0899823X20003839_ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2019.01.026"},{"key":"S0899823X20003839_ref4","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01820-15"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X20003839","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,31]],"date-time":"2020-12-31T08:14:48Z","timestamp":1609402488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X20003839\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,23]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["S0899823X20003839"],"URL":"https:\/\/doi.org\/10.1017\/ice.2020.383","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,23]]},"assertion":[{"value":"\u00a9 2020 by The Society for Healthcare Epidemiology of America. All rights reserved","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}