{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T23:48:00Z","timestamp":1768002480855,"version":"3.49.0"},"reference-count":23,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"name":"VA Merit Review","award":["I0BX002449-01A2"],"award-info":[{"award-number":["I0BX002449-01A2"]}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2016,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Antibiotics have been shown to influence the risk of infection with specific\n Clostridium difficile<\/jats:named-content>\n strains as well as the risk of\n C. difficile<\/jats:named-content>\n infection (CDI). We performed a retrospective case-control study of patients infected with the epidemic BI\/NAP1\/027 strain in a U.S. hospital following recognition of increased CDI severity and culture of stools positive by\n C. difficile<\/jats:named-content>\n toxin immunoassay. Between 2005 and 2007, 72% (103\/143) of patients with first-episode CDIs were infected with the BI strain by restriction endonuclease analysis (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 than among non-BI-infected controls (odds ratio [OR] for fluoroquinolones, 3.2; 95% confidence interval [CI], 1.3 to 7.5; (\n P<\/jats:italic>\n < 0.001; OR for macrolides, 5.2; 95% CI, 1.1 to 24.0;\n P<\/jats:italic>\n = 0.04)). In contrast, clindamycin use was less frequent among the BI cases than among the controls (OR, 0.1; 95% CI, 0.03 to 0.4;\n P<\/jats:italic>\n = 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,\n P<\/jats:italic>\n = 0.0001; azithromycin, 100\/102 [98%] BI versus 22\/40 [55%] non-BI,\n P<\/jats:italic>\n = 0.0001). High-level resistance to clindamycin was more frequent among non-BI strains (22\/40 [55%] non-BI versus 7\/102 [7%] BI,\n P<\/jats:italic>\n = 0.0001). Fluoroquinolone use, macrolide use, and\n C. difficile<\/jats:named-content>\n resistance to these antibiotic classes were associated with infection by the epidemic BI strain of\n C. difficile<\/jats:named-content>\n in a U.S. hospital during a time when CDI rates were increasing nationally due to the highly fluoroquinolone-resistant BI\/NAP1\/027 strain.\n <\/jats:p>","DOI":"10.1128\/aac.01820-15","type":"journal-article","created":{"date-parts":[[2015,11,3]],"date-time":"2015-11-03T01:35:21Z","timestamp":1446514521000},"page":"418-423","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":53,"title":["Fluoroquinolone and Macrolide Exposure Predict Clostridium difficile Infection with the Highly Fluoroquinolone- and Macrolide-Resistant Epidemic C. difficile Strain BI\/NAP1\/027"],"prefix":"10.1128","volume":"60","author":[{"given":"Jeffrey T.","family":"Wieczorkiewicz","sequence":"first","affiliation":[{"name":"Hines VA Hospital, Hines, Illinois, USA"},{"name":"Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bert K.","family":"Lopansri","sequence":"additional","affiliation":[{"name":"Intermountain Medical Center and the University of Utah, Salt Lake City, Utah, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Cheknis","sequence":"additional","affiliation":[{"name":"Hines VA Hospital, Hines, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James R.","family":"Osmolski","sequence":"additional","affiliation":[{"name":"Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Hecht","sequence":"additional","affiliation":[{"name":"Hines VA Hospital, Hines, Illinois, USA"},{"name":"Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dale N.","family":"Gerding","sequence":"additional","affiliation":[{"name":"Hines VA Hospital, Hines, Illinois, USA"},{"name":"Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart","family":"Johnson","sequence":"additional","affiliation":[{"name":"Hines VA Hospital, Hines, Illinois, USA"},{"name":"Loyola University Medical Center, Maywood, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1086\/525047"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199911253412203"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051639"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051590"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/ng.2478"},{"key":"e_1_3_2_7_2","volume-title":"Impact of formulary fluoroquinolone change on inpatient Clostrdium difficile-associated diarrhea","author":"Parada JP","year":"2006","unstructured":"Parada JP, Conway W, Miskevics S, Evans C, LaVela S, Johnson S, Pachucki C, Gerding DN. 2006. Impact of formulary fluoroquinolone change on inpatient Clostrdium difficile-associated diarrhea, abstr 1028. Abstr Infect Dis Soc Am 44th Annu Meet, Toronto, Ontario, Canada, 12 to 15 October 2006."},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.15.3.443-446.1982"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.31.7.1870-1875.1993"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01623-06"},{"key":"e_1_3_2_11_2","volume-title":"Methods for antimicrobial susceptibility testing of anaerobic bacteria, approved standard","author":"CLSI","year":"2007","unstructured":"CLSI. 2007. Methods for antimicrobial susceptibility testing of anaerobic bacteria, approved standard, 7th ed. Clinical and Laboratory Standards Institute, Wayne, PA.","edition":"7"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.41.5.1037"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1086\/522187"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","first-page":"34","DOI":"10.18553\/jmcp.2008.14.1.34","article-title":"Evaluation of Clostridium difficile-associated diarrhea with a drug formulary change in preferred fluoroquinolones","volume":"14","author":"Walbrown MA","year":"2008","unstructured":"Walbrown MA, Aspinall SL, Bayliss NK, Stone RA, Cunningham F, Squier CL, Good CB. 2008. Evaluation of Clostridium difficile-associated diarrhea with a drug formulary change in preferred fluoroquinolones. 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