Impact of System-wide Adoption of CDC Core Elements on Antimicrobial Use and Clostridium difficile Infection in a Large Health System

Abstract

BackgroundInappropriate Antimicrobial use, its associated resistance and suboptimal patient outcomes are important quality and safety concerns. Antimicrobial stewardship programs (ASP) can help reduce the risk of development of multi-drug resistant organisms, and Clostridium difficile infections. The Centers for Disease Control and Prevention (CDC) recommended core elements for successful implementation of ASPs in 2014. We describe the adoption of the core elements and associated outcomes at a large health system in the United States.MethodsWe organized our program based on the seven core elements. We focused on 1) making antimicrobial stewardship a system priority with full leadership support, 2) creating an infrastructure to promote and disseminate best practices, 3) standardizing indications for use of the different antimicrobial classes promoting most narrow-spectrum agents, and 4) building capacity for hospitals to achieve their goals from local leadership buy-in to infrastructure to do the work.ResultsLocal ASPs were established in 89 hospitals. 3.3 million defined daily doses (DDDs) were used in FY15 compared with 2.9 million in FY16 and 2.8 million in FY 17. There was a drop in systemic antimicrobial use from 877 (FY15) to 809 (FY16) and 776 (FY17) DDDs/ 1000 patient-days ((7.7% and 4.1% reduction in FY 16 and FY 17; P <0.001) (Figure 1 and 2). In addition, hospital onset C. difficile lab ID events standardized infection ratios (SIR) dropped from 0.89 (events=2292) in FY15 to 0.84 (events=2056) in FY16 (5.6% reduction) and 0.75 in FY 17 (events=1818), a 10.7% reduction compared with FY16.ConclusionImplementation of the CDC core elements in a very large system has led to both an improvement in total systemic and targeted antibiotic use and reduction in C. difficile infections.Disclosures All authors: No reported disclosures.

Assessment of public health notification thresholds for Clostridioides difficile in acute-care hospitals—Colorado and Tennessee, 2018

“…Significant reductions of CDI in hospital settings have occurred as a result of prevention initiatives, including the CDC's TAP Strategy 13 and the Core Elements Hospital Antibiotic Stewardship Programs. 14 However, at 0.72, the 2018 nationwide SIR for healthcare-facility onset CDI remains greater than the HHS 2020 action goal of an SIR of 0.5. 15 In 2018, according to the CDC's Healthcare-Associated Infections Progress Report, Colorado did not see a significant change in their SIR for CDI from 0.93 in 2017 to 0.88 in 2018.…”