184. Evaluation of Clostridium difficile Infection:  Opportunities to Optimize Antimicrobial Stewardship
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
  • CDI_CB_Poster FINAL 10-2-15.pdf (529.7 kB)
  • Background:

    Clostridium difficileinfection (CDI) rates are a key metric for determining antimicrobial stewardship program (ASP) success. In 2013, our institution implemented an ASP that prospectively audits high-cost, high-impact antimicrobial (daptomycin, linezolid, meropenem, ertapenem, levofloxacin, and piperacillin/tazobactam) use. We evaluated all subsequent CDIs (1) to determine whether they were associated with audited or non-audited antimicrobials and (2) to assess the appropriateness of antimicrobial use.


    We retrospectively reviewed all adult CDIs (first episode) from 09/2013-11/2014 at the University of California, Davis Medical Center. Data collected included demographics, medical co-morbidities, and antecedent antimicrobial use.


    Of the 122 CDIs, 64 (52.4%) occurred in women, 45 (36.8%) in patients with malignancies, and 14 (11.5%) in transplant recipients. Overall, 66 (54.6%) CDIs occurred in patients who received chemotherapy/immunosuppressants, and 32 (26.2%) in patients who received gastric acid-suppressants. The mean patient age was 60.6 years (range: 20-93). Among CDI patients who had received antecedent antimicrobials, 66% (81/122) received non-audited antibiotics only, 32% (39/122) non-audited + audited antibiotics, and 2% (2/122) audited antibiotics only. Commonly prescribed non-audited antecedent antibiotics were vancomycin, cefepime, ceftriaxone, and clindamycin. Antibiotics were used inappropriately in 55/122 (45.1%) of CDIs; of these, a non-audited antibiotic was used in 33 (59.1%). Types of inappropriate prescribing were: antibiotics not indicated (29%), duration too long (27%), definitive therapy too broad (21%), and empiric therapy too broad (15%). The mean length of therapy was 14 days (95% CI: 15.1-19.6) for inappropriate antibiotic use and 10.9 days (95% CI: 10.7-13.9) for appropriate use. 


    The majority of our CDIs were associated with non-audited antimicrobials, and inappropriate prescribing of non-audited antimicrobials was common. It is unlikely that CDI rates can be significantly decreased by ASPs that audit only high-cost, high-impact antimicrobials. We highlight this observation for ASPs that use CDI rates as a metric of success.

    Christine Bui, PharmD1, Elizabeth Zhu, PharmD, BCPS2, Monica Donnelley, PharmD, BCPS1, Machelle D. Wilson, PhD3, Margaret Morita, BS, CIC4, Stuart H. Cohen, MD, FIDSA, FSHEA5 and Jennifer Brown, MD5, (1)Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA, (2)Department of Pharmacy, University of Cailfornia, Davis Medical Center, Sacramento, CA, (3)Department of Public Health Sciences, University of California, Davis, Sacramento, CA, (4)Department of Hospital Epidemiology and Infection Prevention, University of California, Davis Medical Center, Sacramento, CA, (5)Internal Medicine, University of California, Davis Medical Center, Sacramento, CA


    C. Bui, None

    E. Zhu, None

    M. Donnelley, None

    M. D. Wilson, None

    M. Morita, None

    S. H. Cohen, None

    J. Brown, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.