Antimicrobial stewardship programs that target only high-cost, broad-spectrum antimicrobials miss opportunities to reduce Clostridium difficile infections - 19/04/17

Doi : 10.1016/j.ajic.2016.06.025

Christine Bui, PharmD ^a, Elizabeth Zhu, PharmD ^a, Monica A. Donnelley, PharmD ^a, Machelle D. Wilson, PhD ^b, Margaret Morita, BS ^c, Stuart H. Cohen, MD ^d, Jennifer Brown, MD ^d,^*
^a Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA
^b Division of Biostatistics, University of California, Davis Medical Center, Sacramento, CA
^c Department of Hospital Epidemiology and Infection Prevention, University of California, Davis Medical Center, Sacramento, CA
^d Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, CA

^*Address correspondence to Jennifer Brown, MD, Department of Internal Medicine, Division of Infectious Diseases, Davis Medical Center, University of California, 4150 V St, PSSB G-500, Sacramento, CA 95817. (J. Brown).Department of Internal MedicineDivision of Infectious DiseasesDavis Medical CenterUniversity of California4150 V StPSSB G-500SacramentoCA95817

Highlights

•	Most patients who developed Clostridium difficile infection received antimicrobials not audited by the antimicrobial stewardship program.
•	Inappropriate antimicrobial use commonly involved nonaudited antimicrobials.
•	Antimicrobial stewardship programs that focus only on high-cost antimicrobials miss opportunities to reduce Clostridium difficile infections.

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Abstract

Antimicrobial stewardship programs are promoted as a strategy to reduce Clostridium difficile infections. We implemented an antimicrobial stewardship program comprised of formulary restriction plus prospective audit with feedback for high-cost and broad-spectrum antimicrobials. Subsequently, we reviewed all heath care facility–onset, health care facility–associated C difficile infections. We found that most of these infections were associated with the antecedent receipt of nonaudited, and often unnecessary, antimicrobials.

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Key Words : Antimicrobial stewardship, Clostridium difficile

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	Funding/Support: Supported by the National Center for Advancing Translational Sciences, National Institutes of Health through grant UL1 TR000002.
	Previous Presentation: A portion of the study results were presented at IDWeek, October 2015, San Diego, CA.
	Conflicts of Interest: None to report.

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Vol 44 - N° 12

P. 1684-1686 - décembre 2016 Retour au numéro

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Antimicrobial stewardship programs that target only high-cost, broad-spectrum antimicrobials miss opportunities to reduce Clostridium difficile infections - 19/04/17

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