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Lessons Learned from Implementing Clostridium difficile-Focused Antibiotic Stewardship Interventions

Published online by Cambridge University Press:  10 May 2016

B. Ostrowsky ,
R. Ruiz ,
S. Brown ,
P. Chung ,
E. Koppelman ,
C. van Deusen Lukas ,
Y. Guo ,
H. Jalon ,
Z. Sumer  and
C. Araujo
...Show all authors
B. Ostrowsky
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
R. Ruiz
Affiliation:
Greater New York Hospital Association, New York, New York
S. Brown
Affiliation:
Montefiore Medical Center, Bronx, New York
P. Chung
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
E. Koppelman
Affiliation:
Boston University School of Public Health, Boston, Massachusetts
C. van Deusen Lukas
Affiliation:
Boston University School of Public Health, Boston, Massachusetts
Y. Guo
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
H. Jalon
Affiliation:
United Hospital Fund, New York, New York
Z. Sumer
Affiliation:
Greater New York Hospital Association, New York, New York
C. Araujo
Affiliation:
Greater New York Hospital Association, New York, New York
I. Sirtalan
Affiliation:
Greater New York Hospital Association, New York, New York
C. Brown
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
P. Riska
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
B. Currie
Affiliation:
Montefiore Medical Center, Bronx, New York Albert Einstein College of Medicine, Bronx, New York
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Objective.

To determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates.

Design.

A multicenter before-and-after intervention comparative study.

Setting/Participants.

Ten medical centers in the greater New York region. Intervention group comprised of 6 facilities with early antimicrobial stewardship programs (ASPs). The 4 facilities without ASPs made up the nonintervention group.

Interventions/Methods.

Intervention facilities identified target antibiotics using case-control studies and implemented ASP-based strategies to control their use. Pre- and postintervention hospital-onset CDI rates and antibiotic consumption were compared for a 20-month period from June 2010 to January 2012. Antibiotic usage was compared using defined daily dose, days of therapy, and number of courses prescribed. Comparisons used bivariate and regression techniques.

Results.

Intervention facilities identified piperacillin/tazobactam, fluoroquinolones, or cefepime (odds ratio, 2.0-9.8 in CDI case patients compared with those without CDI) as intervention targets and selected several interventions (all included a component of audit and feedback). Varying degrees of success were observed in reducing antibiotic consumption over time. Total target antibiotic use significantly decreased (P < .05) when measured by days of therapy and number of courses but not by defined daily dose. Intravenous moxifloxacin and oral ciprofloxacin use showed significant reduction when measured by defined daily dose and days of therapy (P ≤ .01). Number of courses with all forms of these antibiotics was reduced (P ≤ .005). Intervention hospitals reported fewer hospital-onset CDI cases (2.8 rate point difference) compared with nonintervention hospitals; however, we were unable to show statistically significant decreases in aggregate hospital-onset CDI either between intervention and nonintervention groups or within the intervention group over time.

Conclusions.

Although decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, many valuable lessons (including implementation strategies and antibiotic consumption measures) were learned. The findings can inform potential policy decisions regarding incorporating control of CDI and ASP as healthcare quality measures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S86 - S95
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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