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Moxifloxacin Therapy as a Risk Factor for Clostridium difficile–Associated Disease During an Outbreak: Attempts to Control a New Epidemic Strain

  • Priscilla Biller (a1), Beth Shank (a1), Leah Lind (a2), Meghan Brennan (a3), Lisa Tkatch (a1), George Killgore (a3), Angela Thompson (a3) and L. Clifford McDonald (a3)...


An outbreak of Clostridium difficile-associated disease (CDAD) caused by the epidemic North American pulsed-field gel electrophoresis type 1 (NAP1) strain began after a formulary change from levofloxacin to moxifloxacin. Cases of CDAD were associated with moxifloxacin use, but a formulary change back to levofloxacin failed to reduce rates of disease. Substituting use of one fluoroquinolone with use of another without also controlling the overall use of drugs from this class is unlikely to control outbreaks caused by the NAP1 strain of C. difficile.


Corresponding author

Centers for Disease Control and Prevention, 1600 Clifton Road, MS A35, Atlanta, GA 30333 (


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1.McDonald, LC, Owings, M, Jernigan, DB. Increasing incidence of Clostridium difficile-associated disease in US short-stay hospitals, 1996-2003. Emerg Infect Dis 2006;12:409415.
2.Layton, BA, McDonald, LC, Gerding, DN, Liedtke, LA, Strausbaugh, LJ. Perceived increases in the incidence and severity of Clostridium difficile disease: an emerging threat that continues to unfold. In: Proceedings of the 15th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, Los Angeles, CA, April 4-9, 2005. Abstract.
3.Eggertson, L, Sibbald, B. Hospitals battling outbreaks of Clostridium difficile. CMAJ 2004;171:1921.
4.McDonald, LC, Killgore, GE, Thompson, A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:24332441.
5.Warny, M, Pepin, J, Fang, A, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005;366:10791084.
6.Gaynes, R, Rimland, D, Killum, E, et al. Outbreak of Clostridium difficile infection in a long-term care facility: association with gatifloxacin use. Clin Infect Dis 2004;38:640645.
7.Muto, CA, Pokrywka, MF, Shutt, K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273280.
8.Allen, SD, Emery, CL, Lyerly, DM. Clostridium. In: Murray, PR, Baron, EJ, Jorgensen, JH, Pfaller, MA, Yolken, RH, eds. Manual of Clinical Microbiology. 8th ed. Washington, DC: American Society for Microbiology; 2003:845847.
9.Rupnik, M, Avesani, V, Jane, M, Eichel-Streiber, C, Delmee, M. A novel toxinotyping scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. J Clin Microbiol 1998;36:22402247.
10.Fawley, WN, Wilcox, MH. Pulsed-field gel electrophoresis can yield DNA fingerprints of degradation-susceptible Clostridium difficile strains. J Clin Microbiol 2002;40:35463547.
11.Stubbs, S, Rupnik, M, Gibert, M, Brazier, J, Duerden, B, Popoff, M. Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile. FEMS Microbiol Lett 2000;186:307312.
12.Spigaglia, P, Mastrantonio, P. Molecular analysis of the pathogenicity locus and polymorphism in the putative negative regulator of toxin production (TcdC) among Clostridium difficile clinical isolates. J Clin Microbiol 2002;40:34703475.
13.National Committee for Clinical Laboratory Standards. Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria. 6th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 2004. Approved standard M11-A6.
14.Elixhauser, A, Steiner, C, Harris, DR, Coffey, RM. Comorbidity measures for use with administrative data. Med Care 1998;36:827.
15.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459477.
16.Centers for Disease Control and Prevention. Clostridium difficile—information for healthcare providers. Atlanta, GA: Centers for Disease Control and Prevention; 2005. Available at: dhqp/id_CdiffFAQ_HCP.html. Accessed March 2006.


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