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A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
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Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.

B Ostrowsky1, R Ruiz, S Brown

  • 1Montefiore Medical Center, Bronx, New York.

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|September 16, 2014
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Summary
This summary is machine-generated.

Controlling targeted antibiotic prescriptions did not significantly reduce hospital-onset Clostridium difficile infection (CDI) rates in this study. However, valuable lessons were learned about antimicrobial stewardship programs (ASPs) and antibiotic use measures.

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Area of Science:

  • Infectious Diseases
  • Healthcare Quality Improvement
  • Antimicrobial Stewardship

Background:

  • Hospital-onset Clostridium difficile infection (CDI) remains a significant healthcare-associated infection.
  • Antimicrobial stewardship programs (ASPs) aim to optimize antibiotic use, potentially impacting CDI rates.
  • Controlling specific targeted antibiotics is a strategy explored to reduce CDI.

Purpose of the Study:

  • To evaluate if controlling the prescription of targeted antibiotics leads to a measurable reduction in hospital-onset CDI rates.
  • To assess the impact of ASP-based strategies on antibiotic consumption and CDI incidence.

Main Methods:

  • A multicenter, before-and-after intervention comparative study was conducted across ten medical centers.
  • Six facilities with early ASPs implemented strategies to control targeted antibiotic use (piperacillin/tazobactam, fluoroquinolones, cefepime).
  • Antibiotic consumption and hospital-onset CDI rates were compared pre- and postintervention using various statistical methods.

Main Results:

  • Targeted antibiotic use decreased significantly in terms of days of therapy and number of courses, but not defined daily dose.
  • Specific antibiotics like moxifloxacin and ciprofloxacin showed significant reductions in usage.
  • While intervention hospitals reported fewer CDI cases, the decrease in aggregate hospital-onset CDI was not statistically significant compared to nonintervention hospitals or within the intervention group over time.

Conclusions:

  • Decreases in targeted antibiotic consumption did not directly translate to reduced hospital-onset CDI rates in this study.
  • Valuable insights were gained regarding implementation strategies and antibiotic consumption measurement for ASPs.
  • Findings can inform policy decisions on incorporating CDI control and ASPs as healthcare quality measures.