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Clostridium difficile infection (CDI) is associated with high mortality. Reducing incidence is a priority for patients, clinicians, the National Health Service (NHS) and Public Health England alike. In June 2012, fidaxomicin (FDX) was launched for the treatment of adults with CDI. The objective of this evaluation was to collect robust real-world data to understand the effectiveness of FDX in routine practice. In seven hospitals introducing FDX between July 2012 and July 2013, data were collected retrospectively from medical records on CDI episodes occurring 12 months before/after the introduction of FDX. All hospitalised patients aged ≥18 years with primary CDI (diarrhoea with presence of toxin A/B without a previous CDI in the previous 3 months) were included. Recurrence was defined as in-patient diarrhoea re-emergence requiring treatment any time within 3 months after the first episode. Each hospital had a different protocol for the use of FDX. In hospitals A and B, where FDX was used first line for all primary and recurrent episodes, the recurrence rate reduced from 10.6 % to 3.1 % and from 16.3 % to 3.1 %, with a significant difference in 28-day mortality from 18.2 % to 3.1 % (p < 0.05) and 17.3 % to 6.3 % (p < 0.05) for hospitals A and B, respectively. In hospitals using FDX in selected patients only, the changes in recurrence rates and mortality were less marked. The pattern of adoption of FDX appears to affect its impact on CDI outcome, with maximum reduction in recurrence and all-cause mortality where it is used as first-line treatment.

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Introduction and Objectives COPD is a major cause of mortality/ morbidity in high smoking prevalence Primary Care Trusts (PCTs). Our PCT expected COPD prevalence (3.7%) is therefore high but recorded prevalence (2009/2010) was 1.4%, suggesting large numbers of undiagnosed patients. COPD, as the 2nd commonest cause of emergency admission locally, is one of the most costly diseases for secondary care. Local research (Bastin et al, 2010 1 ) shows that, while most patients admitted for the first time with acute exacerbations of COPD have severe disease, there is no prior diagnosis in w1/3 cases. A COPD Local Enhanced Service (LES) was developed, to incentivise practices to proactively identify, diagnose and manage COPD patients using evidence-based interventions. Methods All GP practices in were invited to participate in the COPD LES. Key elements included number of case finding spirometries performed in smokers/ex-smokers ¼35 y, and provision of interventions (pulmonary rehabilitation (PR) referral, self-management, oxygen auditing) with regular reviews/assessments. Primary outcomes were the number of new COPD diagnoses, a change in the gap between recorded and estimated COPD prevalence and number of non-elective hospital admissions. Data were extracted from the PCT GP dataset, QMAS (diagnosed prevalence), APHO COPDprevalence model (expected prevalence) and Secondary Users Services (hospital admission data). Results 37/38 (97%) GP practices signed up to provide the LES. Between April 2010 and May 2011, 1807 case finding spirometries were performed resulting in an estimated 477 new COPD diagnoses, significantly reducing the undiagnosed COPD prevalence by 0.2% (p<0.05). Compared to the same period in 2009, referrals to PR increased from 78 to 119 (52%) in the first 6/12. Audits of oxygen therapy identified ongoing unnecessary payment in 52 patients (47 died/moved, five patients no longer required oxygen). Twenty-nine patients on LTOT had not been reviewed and were subsequently referred. The LES impact on the rate of emergency admissions for COPD remains unclear. Conclusions One year evaluation demonstrates the COPD-LES is an effective strategy to improve case finding and diagnosis of COPD, improve PR referrals and rationalise oxygen prescribing. Ongoing audit of COPD emergency admissions will determine whether the LES achieves its objective. Introduction Clostridium difficile Infection (CDI) remains a considerable source of healthcare associated infection. A Department of Health briefing recommends all Trusts establish an antimicrobial management team (AMT) to develop an antibiotic stewardship programme aiming to reduce CDI rates through appropriate antibiotic prescribing.1 As a result, collaborative antimicrobial ward rounds were initiated in the Trust in May 2009. Aim To study the impact of collaborative ward rounds on antibiotic prescribing within the Respiratory Directorate. Method A weekly collaborative ward round model comprising of a Consultant microbiologist, Respiratory pharmacist and the Consultant Infec...