1015. Lessons Learned from Implementation of Clostridium difficile focused Antibiotic Stewardship
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Clostridium difficile infection (CDI) rates continue to rise. Our objective was to determine if controlling prescribing of target antibiotics would translate to a measureable reduction in hospital onset (HO) CDI rates.

Methods: A multicenter, before and after intervention comparative study was performed at ten medical centers in the greater New York City area. The intervention group comprised of six facilities with early antimicrobial stewardship programs (ASPs).  The four facilities without ASPs made up the control group.  Intervention facilities identified target antibiotics using limited case-control studies and implemented ASP-based strategies to control their use.  Pre- and post-intervention 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 (DDD), duration of therapy (DOT), and number of courses (NOC) prescribed.  Comparisons used bivariate and regression techniques.      

Results: Intervention facilities identified piperacillin/tazobactam, fluoroquinolones, or cefepime (OR 2.0-9.8) as intervention targets and selected several interventions (all included a component of audit and feedback as one intervention strategy).  Varying degrees of success were observed in reducing antibiotic consumption over time.  Total target antibiotic use significantly decreased (p<0.05) when measured by DOT and NOC but not by DDD.  Intravenous moxifloxacin and oral ciprofloxacin use showed significant reduction when measured by DDD and DOT (p≤0.01).  NOC with all forms of these antibiotics were reduced (p<0.005). Intervention hospitals reported fewer HO CDI cases (2.8 rate point difference) compared to control hospitals;  however we were unable to show a statistical decrease in HO CDI over time, either between these groups or within the intervention group. 

Conclusion: Although decreases in target antibiotic consumption did not translate into reductions of HO CDI in the current study, many valuable lessons (including some involving implementation strategies and antibiotic consumption metrics) were learned.

Belinda Ostrowsky, MD, MPH1,2, Shakara Brown, MPH1, Philip Chung, PharmD, MS1,2, Raphael Ruiz, PhD3, Elisa Koppelman, MSW4, Carol Van Deusen Lukas, Ed.D.4, Yi Guo, PharmD1,2, Hillary Jalon5, Zeynep Sumer3, Cynthia Araujo3, Ismail Sirtalan, PhD3, Claire Brown, MD1,2, Paul Riska, MD1,2 and Brian P. Currie, MD, MPH1,2, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY, (3)Greater New York Hospital Association, New York, NY, (4)Boston University School of Public Health, Boston, MA, (5)United Hospital Fund, New York, NY

Disclosures:

B. Ostrowsky, None

S. Brown, None

P. Chung, None

R. Ruiz, None

E. Koppelman, None

C. Van Deusen Lukas, None

Y. Guo, None

H. Jalon, None

Z. Sumer, None

C. Araujo, None

I. Sirtalan, None

C. Brown, None

P. Riska, BD GeneOhm: Grant Investigator, Grant recipient
Cubist: Grant Investigator, Grant recipient

B. P. Currie, None

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