Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection

The study objective was to determine whether there was an improvement in compliance with recommended Clostridium difficile infection (CDI) treatment after introduction of an institutional CDI bundle with daily antimicrobial stewardship assessment. This was a single-centre, quasi-experimental study e...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2016-03, Vol.71 (3), p.836-840
Main Authors: Brumley, Paul E, Malani, Anurag N, Kabara, Jared J, Pisani, Jennifer, Collins, Curtis D
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Antimicrobial agents
Bacterial infections
Clostridium difficile
Clostridium difficile - drug effects
Clostridium difficile - isolation & purification
Clostridium Infections - chemically induced
Clostridium Infections - drug therapy
Clostridium Infections - microbiology
Drug therapy
Drug Utilization - standards
Female
Gram-positive bacteria
Guideline Adherence
Humans
Male
Middle Aged
Non-Randomized Controlled Trials as Topic
Organizational Policy
Patient admissions
Patient Readmission
Survival Analysis
Treatment Outcome
Young Adult
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Summary:The study objective was to determine whether there was an improvement in compliance with recommended Clostridium difficile infection (CDI) treatment after introduction of an institutional CDI bundle with daily antimicrobial stewardship assessment. This was a single-centre, quasi-experimental study evaluating compliance with an antimicrobial stewardship team-implemented care bundle in patients with CDI compared with historical controls. The primary outcome, compliance with overall bundle elements, was achieved when the following measures were accomplished: (i) appropriate CDI antimicrobial therapy based on the institutional treatment algorithm; (ii) discontinuation of acid-suppressant therapy in the absence of a pre-specified indication; and (iii) discontinuation of unnecessary antimicrobials. Secondary objectives were to evaluate the extent to which antimicrobial stewardship involvement affected treatment compliance and to assess trends in CDI clinical outcomes, such as mortality and readmission. One-hundred-and-sixty-nine patients were evaluated; 83 after implementation of the care bundle (bundle group) and 89 prior to bundle implementation (historical control group). Compliance with overall bundle endpoints was significantly higher in the bundle group versus the control group (81% versus 45%, P 
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkv404