239. Implementation of a Vertical Antimicrobial Stewardship Intervention for Patients Colonized with Clostridium difficile
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Clostridium difficile remains a pathogen of importance as global infections steadily rise. While traditionally thought of as a nosocomial infection, C. difficile prevalence is increasing in the community. This may be due partly to asymptomatic gastrointestinal colonization with C. difficile. Disruption of the gut microbiome in colonized patients (pts) through use of antibiotics (ABX) and acid suppressive therapy (AST) may lead to active colitis. In an effort to prevent progression to active disease, a novel vertical antimicrobial stewardship (AMS) intervention was initiated at our hospital on May 1, 2017. This study aims to describe our experience with this intervention.

Methods: This single center, descriptive study evaluated the impact of a vertical AMS intervention for pts colonized with C. difficile as identified by surveillance nucleic acid amplification test (NAAT) upon hospital admission. Between May 1 and Dec 10, 2017, pts on 5 units [2 hematology/ oncology (HO), solid organ transplant (SOT), intensive care unit (ICU), medicine ward (MED)] were screened, with surveillance results reported to the AMS team. Positive results prompted the AMS pharmacists to evaluate pts for potential ABX and AST de-escalation interventions (INTV) daily until discharge.




Total pts


Pts on ABX

no. (%)


no. (%)

ABX INTV Accepted

no. (%)

Pts on AST

no. (%)


no. (%)

AST INTV Accepted

no. (%)

Pts that Developed Active Colitis

no. (%)*



36 (72)

4 (11)

3 (75)

35 (70)

8 (23)

6 (75)

6 (12)



86 (81)

15 (17)

9 (60)

84 (79)

23 (27)

16 (70)

18 (17)



27 (56)

7 (26)

5 (71)

29 (60)

8 (28)

7 (88)

6 (13)



44 (72)

7 (16)

6 (86)

42 (69)

10 (24)

5 (50)

7 (11)



193 (73)

33 (17)

23 (70)

190 (72)

49 (26)

34 (69)

37 (14)

*active colitis: (NAAT+/Enzyme Immunoassay [EIA]+) or NAAT+/EIA- with symptoms

Of the 37 pts who developed active colitis, ABX INTVs were made on 6 (16%) with 33% acceptance and AST INTVs were made on 10 (27%) with 50% acceptance.

Conclusion: Rate of progression from colonization to colitis was low in all patient populations studied, despite high rates of ABX and AST use. Further research into what causes progression from colonization to colitis is needed.

Sara Revolinski, PharmD, BCPS1, Christina Tran, PharmD2, Angela Huang, PharmD, BCPS-AQ ID1, Njeri Wainaina, MD3 and L. Silvia Munoz-Price, MD, PhD4, (1)Froedtert & The Medical College of Wisconsin, Milwaukee, WI, (2)Froedtert & the Medical College of Wisconsin, Milwaukee, WI, (3)Infectious Disease, Medical College of Wisconsin, Milwaukee, WI, (4)Medicine, Medical College of Wisconsin, Milwaukee, WI


S. Revolinski, None

C. Tran, None

A. Huang, None

N. Wainaina, None

L. S. Munoz-Price, None

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