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Antibiotic prescribing policy and Clostridium difficile diarrhoea
K A O'Connor1, M Kingston, M O'Donovan
1South Munster Geriatric Training Scheme, Departments of Geriatric Medicine, Cork University Hospital, Cork, and St. Finbarr's Hospital, Cork, Ireland.
QJM : Monthly Journal of the Association of Physicians
|June 23, 2004
Summary
Changing antibiotic policies to reduce intravenous cephalosporin use significantly decreased Clostridium difficile diarrhoea cases in elderly patients. This study highlights effective antimicrobial stewardship for preventing hospital-acquired infections.
Area of Science:
- Infectious Diseases
- Antimicrobial Stewardship
- Hospital Epidemiology
Background:
- Broad-spectrum antibiotics, especially intravenous cephalosporins, are linked to Clostridium difficile (C. diff) diarrhoea.
- C. diff diarrhoea is an increasing concern in hospitals, particularly affecting elderly individuals.
Purpose of the Study:
- To determine if modifying antibiotic policies to decrease injectable cephalosporin use reduces C. diff diarrhoea incidence in elderly patients.
- Evaluating the impact of antimicrobial stewardship interventions on hospital-acquired infections.
Main Methods:
- Retrospective analysis comparing patient groups before and after July 2000, when a new antibiotic policy was implemented.
- Data collection included infections, antibiotic prescriptions, mortality rates from case notes, and C. diff diarrhoea rates from microbiological data.
Main Results:
- Intravenous cephalosporin use decreased significantly (210 to 28 defined daily doses; p < 0.001) post-policy change.
- C. diff diarrhoea cases were significantly reduced, with a relative risk of 3.24 for the old policy versus the new (95%CI 1.07-9.84, p = 0.03).
- Increased use of piperacillin-tazobactam and moxifloxacin was observed (p < 0.001).
Conclusions:
- The revised antibiotic policy was successfully implemented in an elderly care setting.
- The policy effectively reduced both intravenous cephalosporin prescribing and the incidence of C. diff diarrhoea.