Decreasing ICU-associated Clostridioides difficile infection through fluoroquinolone restriction, the FIRST trial: a...

Area of Science:

• Infectious Diseases
• Healthcare Epidemiology
• Antibiotic Stewardship

Background:

• Clostridioides difficile infection (CDI) is a common healthcare-associated infection, particularly in intensive care units (ICUs).
• Fluoroquinolone (FQ) antibiotic use is a significant risk factor for CDI.
• Effective antibiotic stewardship (AS) interventions are needed to control CDI, but evidence on optimal strategies is limited.

Purpose of the Study:

• To evaluate the effectiveness of fluoroquinolone (FQ) pre-prescription authorization (PPA) in reducing CDI rates in adult ICUs.
• To assess the implementation effectiveness of an FQ PPA intervention using a human-factors and systems engineering model.

Main Methods:

• A multisite, stepped-wedge, cluster, effectiveness-implementation clinical trial involving 12 adult medical-surgical ICUs.
• Implementation of an FQ PPA intervention via an EHR-integrated clinical decision support system.
• Comparison of outcomes (ICU-onset CDI rates, antibiotic days of therapy, length of stay, mortality) between intervention and pre-intervention periods.

Main Results:

• Data on CDI rates, FQ and alternative antibiotic use, length of stay, and mortality were collected.
• Implementation data were gathered to assess the effectiveness of the intervention's integration into clinical workflows.
• Statistical analysis compared outcomes during the intervention period against baseline data.

Conclusions:

• The FQ Restriction for the Prevention of CDI (FIRST) trial provides crucial data on the effectiveness of FQ PPA as an AS intervention.
• Findings will inform best practices for CDI prevention and antibiotic stewardship in critical care settings.
• The study contributes to understanding the implementation of novel AS strategies in complex healthcare environments.