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.
M. Donnelley, None
M. D. Wilson, None
M. Morita, None
S. H. Cohen, None
J. Brown, None
See more of: Poster Abstract Session