<p>Interprofessional Antimicrobial Stewardship Influencing <em>Clostridioides difficile</em> Infection: An 8-Year Study Using Antimicrobial Use Density</p>

Abstract

PurposeTo reduce Clostridioides difficile infection (CDI), we implemented interprofessional antimicrobial, infection control, and diagnostic stewardship (ipAS) conducted by physicians/pharmacists, infection control nurses, and medical technologists, respectively. As a numerical indicator for ipAS, we used antimicrobial use density (AUD) in an 8-year study to validate its efficacy in CDI reduction.Patients and methodsThis was an observational study. CDI was defined as stool samples or C. difficile isolates containing toxin A and/or B from a patient with diarrhea occurring three or more times per day. From 2011–2018 at a 10-ward single site the subjects were in-patients with CDI, and the following data were collected: AUDs for 23 antibiotics, and antimicrobial test results. By 2015, we had established ipAS, consisting of culture submission before the administration of broad-spectrum antimicrobials, the promotion of point-of-care testing for diagnosis-based antimicrobials, perioperative prophylactic antibiotics, intervention at positive diagnosis of blood culture, team round for diarrhea, and inspection on contact precautions and disinfection in CDI cases. The study outcomes included annual numbers of CDI patients and blood culture sets. We compared annual AUDs between former (2011–14) and latter (2015–18) periods using Kruskal–Wallis tests and examined the correlation between AUDs and CDI numbers.ResultsOf a total 50,970 patients, 1,750 patients underwent C. difficile toxin tests, of whom 171 patients (9.8%) were positive for CDI. Between the former and latter periods, AUDs for flomoxef (11.96 to 2.71 by medians), panipenem/betamipron (0.30 to 0.00), and clindamycin (3.87 to 2.19) significantly decreased (P<0.05) as did numbers of CDIs (26.5 to 10) (P=0.043). The correlation analysis revealed a significant correlation between AUD for flomoxef and CDIs (P=0.004) and the AUD for piperacillin/tazobactam and CDIs (P=0.010) with a positive Pearson r.ConclusionThe integrated antimicrobial, diagnostic, and infection control approach used in ipAS may reduce CDIs.

Bibliometric analysis of peer-reviewed literature on antimicrobial stewardship from 1990 to 2019

“…The current study indicated that C. difficile was frequently encountered author keyword in the retrieved literature on AMS [ 50 – 58 ]. In the 2019 Antibiotic Resistance Threats Report, the U.S. CDC has declared C. difficile infections as an urgent threat [ 59 , 60 ].…”

“…The impact of AMS programs on CDI is controversial. Certain studies indicated that AMS caused a significant reduction in C. difficile infections [ 52 , 53 ] while other studies did not [ 50 , 57 , 58 ].…”

Evaluation of hospital pharmacists’ activities using additional reimbursement for infection prevention as an indicator in small and medium-sized hospitals

“…In this study, with the average length of hospital stay as the outcome, the correlation with the average number of beds per pharmacist remained weak ( R = 0.322), even in ARIP 2 hospitals. One reason could be that infection control is often achieved through an integrated approach involving different professionals [ 11 ]. However, various pharmacist-led initiatives have been reported to promote the use of antimicrobial agents, improve achievement rate of effective blood concentration range in vancomycin (VCM) therapy [ 12 ], reducing the rate of MRSA in intensive care units and in antimicrobial allergic reactions [ 13 – 16 ].…”