Associations Between Antimicrobial Stewardship Program Elements and Clostridium difficile Infection Performance

Background: National hospital performance measures for healthcare-facility onset C. difficile infection (HO-CDI) are available on Hospital Compare website in the form of a Standardized Infection Ratio (SIR) category of either ‘Better’, ‘No different’, or ‘Worse’ than a national benchmark.  Comparing Antimicrobial Stewardship Program (ASP) structural elements and strategies among hospital HO-CDI SIR categories may aid in identifying strategies that decrease HO-CDI.

Methods: Survey data were collected in 2013 on 44 academic medical center ASPs regarding: ASP member types (pharmacist, physician) and full-time equivalents; ASP duration; whether certain strategies were in place (prior authorization, post-prescription review); number of CDI high-risk antibiotics (quinolone, 3^rd cephalosporin, carbapenem, beta-lactam/beta-lactamase inhibitor) restricted; whether there were CDI-specific prevention strategies; whether benchmarking and automated surveillance software were used.  SIR categories were obtained from Hospital Compare.  To compare ASP elements between hospitals with SIR category of “Better” to those with either “No different” or “Worse,” chi-square tests were used.

Results: Among hospitals, 32% were ‘Better’, while 68% were ‘No different’ (n = 17) or ‘Worse’ (n = 13). The Figure displays the percent of ASP elements met by SIR category. Responses regarding whether a hospital performed post-prescription review were statistically significant across SIR categories with 71% of ‘Better’ vs. 97% of ‘No different’/‘Worse’ hospitals performing this strategy; p < 0.05.  

 

Conclusion: More ‘Worse’/‘No different’ hospitals utilized post-prescription review as compared to ‘Better’ hospitals. This may infer that only performing retroactive interventions is not the most successful method for ASPs to decrease HO-CDI. Though not significant, more ‘Better’ hospitals performed prior-authorization and with greater number of high-risk antibiotics, and this could be an area for additional analysis with a larger sample size.