Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions

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.