Antibiotic Stewardship Program Impact on Clostridium difficile Incidence in a 232 Bed Community Hospital

Background: An Antibiotic Stewardship Program was implemented at St. Tammany Parish Hospital in July, 2013.  The team’s core members included an infectious disease physician, Hospital Medicine, a clinical pharmacist, a microbiologist, and an infection preventionist. 

Methods: A prospective review and direct intervention with prescribers was initiated. The analysis included antibiotic choice, indication, and duration; as well as patient outcomes.   Strategies included tracking the use of antibiotics through real time review and direct intervention with prescribers.  

Results: Outcome analysis – Clostridium difficile Standard Infection Ratio (SIR); Antibiotic Defined Daily Doses; Cost of Antibiotic per Adjusted Patient Day; and Cost Related to Treatment of Clostridium difficile

Conclusion:Patient safety has been impacted as seen by a reduced Standard Infection Ratio (SIR).  The Clostridium difficile SIR decreased from 0.85 in 2013 to annualized 2016 SIR of 0.57.  The decrease in Clostridium difficile infections not only improved the patients’ physical well-being, there were significant financial savings for the hospital.  The average cost of treating Clostridium difficile is $7,500 per case; the decrease in the incidence of Clostridium difficile over the three years resulted in a cost savings of over $375,000.  In addition, the antibiotic cost per adjusted patient day dropped from a high of $25.93 to a low of $5.67.  This change in antibiotic utilization has resulted in a cumulative savings of $1.5 million.