Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Dec 1;44(12):1539-1543.
doi: 10.1016/j.ajic.2016.05.027. Epub 2016 Aug 31.

Effect of an antimicrobial stewardship intervention on outcomes for patients with Clostridium difficile infection

Hanna K Welch  1 , Jerod L Nagel  2 , Twisha S Patel  2 , Tejal N Gandhi  3 , Benrong Chen  4 , John De Leon  1 , Carol E Chenoweth  3 , Laraine L Washer  5 , Krishna Rao  6 , Gregory A Eschenauer  7
Affiliations

Effect of an antimicrobial stewardship intervention on outcomes for patients with Clostridium difficile infection

Hanna K Welch et al. Am J Infect Control. .

Abstract

Background: Although antimicrobial stewardship programs (ASPs) are uniquely positioned to improve treatment of Clostridium difficile infection (CDI) through targeted interventions, studies to date have not rigorously evaluated the influence of ASP involvement on clinical outcomes attributed to CDI.

Methods: We performed a quasiexperimental study of adult patients with CDI before (n = 307) and after (n = 285) a real-time ASP review was initiated. In the intervention group, an ASP pharmacist was notified of positive CDI results and consulted with the care team to initiate optimal therapy, minimize concomitant antibiotic and acid-suppressive therapy, and recommend surgical/infectious diseases consultation in complicated cases. The primary outcome was a composite of attributable 30-day mortality, intensive care unit admission, colectomy/ileostomy, and recurrence.

Results: A higher percentage of patients in the ASP intervention group had acid-suppressive therapy discontinued (30% vs 13%; P < .01). Among patients with severe CDI, more patients in the intervention group received an infectious diseases consultation (17% vs 10%; P = .04), received appropriate therapy with oral vancomycin (87% vs 59%; P <.01), and vancomycin was initiated earlier (mean, 1.1 vs 1.7 days; P <.01). Incidence of the composite outcome was not significantly different between the 2 groups (12.3% vs 14.7%; P = .40).

Conclusions: ASP review and intervention improved CDI process measures. A decrease in composite outcomes was not found, which may be due to low baseline rates of attributable complications in our institution.

Keywords: Colitis; Oral vancomycin; Proton pump inhibitors.

PubMed Disclaimer

References

    1. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372(9):825–834. - PMC - PubMed
    1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370(13):1198–1208. - PMC - PubMed
    1. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: A meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173(22):2039–2046. - PubMed
    1. Modena S, Gollamudi S, Friedenberg F. Continuation of antibiotics is associated with failure of metronidazole for Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2006;40(1):49–54. - PubMed
    1. Pop-Vicas A, Shaban E, Letourneau C, Pechie A. Empirical antimicrobial prescriptions in patients with Clostridium difficile infection at hospital admission and impact on clinical outcome. Infect Control Hosp Epidemiol 2012;33(11):1101–1106. - PubMed

MeSH terms

Substances