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Broad-spectrum antibiotic use is a risk factor for Clostridium difficile-associated diarrhea (CDAD). Prompted by a mounting incidence of CDAD, a veterans hospital tried educating the staff on barrier precautions and isolation procedures, but this did not stem the increase. Physicians subsequently noted a sharp increase in clindamycin-resistant C. difficile in stool samples from inpatients who developed diarrhea, leading the hospital to limit clindamycin prescribing by requiring approval from an infectious disease consultant.
During the year after the restriction was implemented, clindamycin use decreased 87 percent, CDAD decreased significantly (from 11.7 to 5.7 cases per month), and clindamycin resistance in C. difficile isolates decreased …