923. Consensus Definition of Clostridium Difficile Infections That Are Not Preventable by Antibiotic Stewardship Programs
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall

Background:  Clostridium difficile infection (CDI) is now frequently seen in both healthcare and community settings and is an urgent public health threat.  The incidence and impact of CDI could be reduced with effective implementation of antibiotic stewardship interventions. Not all CDIs are preventable. However, the categories of CDIs that are expectedly preventable with antibiotic stewardship practices remain poorly described.

Methods: We presented 11 different clinical cases of CDI to 22 infectious disease physicians and fellows at Duke University Medical Center from January 2014 through May 2015. Using a Likert scale, respondents ranked whether a case of CDI was preventable or unpreventable by the current inpatient antibiotic stewardship program (ASP) at Duke (which consists of antibiotic restriction, antibiotic approval and post-prescription review).  A two-round Delphi method was used to try to achieve consensus. Twenty individuals responded in the first round; only 10 of those 22 responded in the second round. Greater than 80% agreement after round two was considered consensus.

Results: Respondents considered 4 out of 11 scenarios of CDI were not preventable by the ASP (Table). These non-preventable scenarios included: community onset CDI, community-onset healthcare associated, hospital-onset CDI without antibiotic exposure, and relapsed hospital-onset CDI. There was no scenario of CDI that respondents agreed was definitely preventable by ASP (requiring agreement >80% responses). No consensus could be reached over preventability by ASP for seven out of remaining eleven scenarios of CDI.

Conclusion:  Infectious Disease physicians agreed that four categories of CDIs are not preventable with inpatient ASPs. The follow-on study from this preliminary work is to apply the above consensus definition to a representative cohort of CDI and better understand the proportion of CDI that ASP could not impact and thus require a different prevention strategy.  

Jessica Seidelman, M.D.1, Kristen V. Dicks, MD2, Sarah S. Lewis, MD MPH2,3, Michael J. Durkin, MD, MPH2, Arthur W. Baker, MD, MPH2, Rebekah W. Moehring, MD, MPH2,3, Deverick Anderson, MD, MPH, FIDSA, FSHEA2,3, Daniel J. Sexton, MD, FIDSA, FSHEA2,3 and Luke F. Chen, MBBS, MPH, CIC, FRACP2,3, (1)Internal Medicine, Duke University, Durham, NC, (2)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (3)Duke University CDC Prevention Epicenter Program, Durham, NC


J. Seidelman, None

K. V. Dicks, None

S. S. Lewis, None

M. J. Durkin, None

A. W. Baker, None

R. W. Moehring, None

D. Anderson, None

D. J. Sexton, None

L. F. Chen, None

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