ABSTRACT.Purpose: The purpose of this study was to construct a new clinical tool for establishing levels of indications for cataract surgery, and to validate this tool. Methods: Teams from nine eye clinics reached an agreement about the need to develop a clinical tool for setting levels of indications for cataract surgery and about the items that should be included in the tool. The tool was to be called 'NIKE' (Nationell Indikationsmodell fo¨r Kataraktextraktion). The Canadian Cataract Priority Criteria Tool served as a model for the NIKE tool, which was modified for Swedish conditions. Items included in the tool were visual acuity of both eyes, patients' perceived difficulties in day-to-day life, cataract symptoms, the ability to live independently, and medical ⁄ ophthalmic reasons for surgery. The tool was validated and tested in 343 cataract surgery patients. Validity, stability and reliability were tested and the outcome of surgery was studied in relation to the indication setting. Results: Four indication groups (IGs) were suggested. The group with the greatest indications for surgery was named group 1 and that with the lowest, group 4. Validity was proved to be good. Surgery had the greatest impact on the group with the highest indications for surgery. Test-retest reliability test and interexaminer tests of indication settings showed statistically significant intraclass correlations (intraclass correlation coefficients [ICCs] 0.526 and 0.923, respectively). Conclusions: A new clinical tool for indication setting in cataract surgery is presented. This tool, the NIKE, takes into account both visual acuity and the patient's perceived problems in day-to-day life because of cataract. The tool seems to be stable and reliable and neutral towards different examiners.

Clostridium difficile infections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000-bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (؎ standard error of the mean [SEM]) of 1,038 ؎ 109 DDD per month (period 1) to 42 ؎ 10 DDD per month (period 2) (P ‫؍‬ 0.0045). Total antibiotic use was not affected. The mean (؎SEM) numbers of CDI cases in period 1 were 59 ؎ 3 per month and in period 2 were 32 ؎ 3 per month (46% reduction; P ‫؍‬ 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.C lostridium difficile infection (CDI) is a common side effect of antimicrobial therapy, and C. difficile is endemic in hospitals due to health care-associated transmissions. CDI is associated with increased mortality rates and economic burden (1, 2). Although several substances can cause CDI, the risk differs between individual antibiotics. A recent meta-analysis of community-associated CDI comprising 30,184 patients (3) showed that the risk for CDI was greatest with clindamycin (odds ratio [OR], 20.43; 95% confidence interval [CI], 8.50 to 49.09), followed by fluoroquinolones (OR, 5.65; 95% CI, 4.38 to 7.28).

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