Program Schedule

189
Hospital onset Clostridium difficile infection not a predictor of increased antibiotic use in small hospitals: an evaluation of 54 hospitals

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Cdiff-IDSA-14.pdf (201.3 kB)
  • Background: Clostridium difficile infection (CDI) is one of the leading healthcare-associated infections in the United States. Antimicrobial pressure has been linked to increased incidence, severity and recurrences of CDI. As the initial step for development of a system-wide antimicrobial stewardship program for a large health system, we evaluated the relationship between antimicrobial use and hospital onset (HO) CDI standard infection ratio (SIR).

    Methods: CDI SIRs were compared to the use of specific classes of penicillin, cephalosporin, carbapenem, quinolone, clindamycin, tigecycline, and total antimicrobials (defined daily dose/1000 patient days) among 54 hospitals in one health system for the year 2013. Antimicrobial use and HO CDI SIR were compared factoring yearly patient days (≤25,000; 25,001-50,000; 50,001-75,000; >75,001) categories.

    Results: The highest antimicrobial use per 1000 patient-days was in groups with <25,000 patient days per year, (1177/1000 patient-days). In addition, these hospitals represented the highest use of 3rd generation cephalosporins, extended spectrum penicillins, and quinolones (Table). However, HO CDI SIR did not correlate with increased antimicrobial use, and was associated with hospitals with patient-days >50,000 per year.

    Conclusion: Hospitals with lower patient days had the highest use of antimicrobial agents, and represent an important opportunity to target the antimicrobial stewardship efforts. On the other hand, CDI SIR may not be a good surrogate to evaluate their antimicrobial stewardship outcomes.

    Antibiotic Defined Daily Doses per 1000 patient-days in the 54 hospitals grouped by patient-days in 2013:

    ≤25,000 patient-days (n=18)

    25,001-50,000 patient-days (n=9)

    50,001-75,000 patient-days (n=9)

    >75,000 patient-days (n=18)

    Total mean

    P-value

    All antimicrobials

    1177389

    716211

    782225

    695256

    874363

    <0.001

    3rd generation cephalosporins

    150122

    6522

    8440

    6231

    9583

    0.005

    Carbapenems

    2616

    3741

    3327

    2816

    2923

    0.66

    Extended spectrum penicillins

    196117

    14168

    3913

    4210

    146102

    0.007

    Quinolones

    249145

    14871

    16877

    192155

    200133

    0.23

    Hospital onset CDI Standardized infection ratio

    0.570.37

    0.680.38

    0.970.48

    0.850.26

    0.750.38

    0.036

    Roy Guharoy, PharmD, MBA1, Mohamad G. Fakih, MD, MPH2, Jeffrey Seggerman, MBA3, Angelo Bufalino, Ph.D.4, Michelle Heavens, BSN, MHA5 and Ann Hendrich, RN, PhD5, (1)Clinical Excellence, University of Massachusetts Health Care, St. Louis, MO, (2)Infection Prevention and Control, St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (3)Ascension Health, St Louis, MO, (4)Ascension Health, St. Louis, MO, (5)Clinical Excellence, Ascension Health, St Louis, MO

    Disclosures:

    R. Guharoy, None

    M. G. Fakih, None

    J. Seggerman, None

    A. Bufalino, None

    M. Heavens, None

    A. Hendrich, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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