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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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| Published in: | Journal of antimicrobial chemotherapy 2016-03, Vol.71 (3), p.836-840 |
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| Main Authors: | , , , , |
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| cites | cdi_FETCH-LOGICAL-c348t-6cbf7ed25df09107132bec1cbce931e454f92c48829196b5d0be39441fa416e23 |
| container_end_page | 840 |
| container_issue | 3 |
| container_start_page | 836 |
| container_title | Journal of antimicrobial chemotherapy |
| container_volume | 71 |
| creator | Brumley, Paul E Malani, Anurag N Kabara, Jared J Pisani, Jennifer Collins, Curtis D |
| description | 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 |
| doi_str_mv | 10.1093/jac/dkv404 |
| format | article |
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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 < 0.001). Individual bundle components that were significantly improved in the bundle group were discontinuation of non-essential acid suppressants (90% versus 18%, P < 0.001) and administration of appropriate CDI therapy (82% versus 64%, P < 0.009). No significant differences were observed in overall or CDI-related mortality or readmissions, durations of therapy or reduction of non-essential concomitant antimicrobials.
Introduction of an antimicrobial stewardship bundle for CDI significantly improved adherence to institutional treatment recommendations and overall management of patients with CDI.</description><identifier>ISSN: 0305-7453</identifier><identifier>EISSN: 1460-2091</identifier><identifier>DOI: 10.1093/jac/dkv404</identifier><identifier>PMID: 26661392</identifier><language>eng</language><publisher>England: Oxford Publishing Limited (England)</publisher><subject>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</subject><ispartof>Journal of antimicrobial chemotherapy, 2016-03, Vol.71 (3), p.836-840</ispartof><rights>The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford Publishing Limited(England) Mar 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c348t-6cbf7ed25df09107132bec1cbce931e454f92c48829196b5d0be39441fa416e23</citedby><cites>FETCH-LOGICAL-c348t-6cbf7ed25df09107132bec1cbce931e454f92c48829196b5d0be39441fa416e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26661392$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brumley, Paul E</creatorcontrib><creatorcontrib>Malani, Anurag N</creatorcontrib><creatorcontrib>Kabara, Jared J</creatorcontrib><creatorcontrib>Pisani, Jennifer</creatorcontrib><creatorcontrib>Collins, Curtis D</creatorcontrib><title>Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection</title><title>Journal of antimicrobial chemotherapy</title><addtitle>J Antimicrob Chemother</addtitle><description>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 < 0.001). Individual bundle components that were significantly improved in the bundle group were discontinuation of non-essential acid suppressants (90% versus 18%, P < 0.001) and administration of appropriate CDI therapy (82% versus 64%, P < 0.009). No significant differences were observed in overall or CDI-related mortality or readmissions, durations of therapy or reduction of non-essential concomitant antimicrobials.
Introduction of an antimicrobial stewardship bundle for CDI significantly improved adherence to institutional treatment recommendations and overall management of patients with CDI.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antimicrobial agents</subject><subject>Bacterial infections</subject><subject>Clostridium difficile</subject><subject>Clostridium difficile - drug effects</subject><subject>Clostridium difficile - isolation & purification</subject><subject>Clostridium Infections - chemically induced</subject><subject>Clostridium Infections - drug therapy</subject><subject>Clostridium Infections - microbiology</subject><subject>Drug therapy</subject><subject>Drug Utilization - standards</subject><subject>Female</subject><subject>Gram-positive bacteria</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Non-Randomized Controlled Trials as Topic</subject><subject>Organizational Policy</subject><subject>Patient admissions</subject><subject>Patient Readmission</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0305-7453</issn><issn>1460-2091</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqN0clKBDEQBuAgio6jFx9AAl5EaK0sne4cZXCDAS96btJZMGMvY5JWfHszjHrwJATq8vFTlR-hEwKXBCS7Wil9ZV7fOfAdNCNcQEFBkl00AwZlUfGSHaDDGFcAIEpR76MDKoQgTNIZam6cszrh0WE15Jd873UYW686HJP9UMHEF7_G7TSYzmI3BrxWydshRfzh0wtedGNMwRs_9dh457z22flhk-rH4QjtOdVFe_w95-j59uZpcV8sH-8eFtfLQjNep0Lo1lXW0NK4vDpUhNHWaqJbbSUjlpfcSap5XVNJpGhLA61lknPiFCfCUjZH59vcdRjfJhtT0_uobdepwY5TbEhVQ8mA8-ofVFApgJd1pmd_6GqcwpAP2ShZkZoDZHWxVfnjYgzWNevgexU-GwLNpqEmN9RsG8r49DtyantrfulPJewLxjaMwQ</recordid><startdate>201603</startdate><enddate>201603</enddate><creator>Brumley, Paul E</creator><creator>Malani, Anurag N</creator><creator>Kabara, Jared J</creator><creator>Pisani, Jennifer</creator><creator>Collins, Curtis D</creator><general>Oxford Publishing Limited (England)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QO</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201603</creationdate><title>Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection</title><author>Brumley, Paul E ; Malani, Anurag N ; Kabara, Jared J ; Pisani, Jennifer ; Collins, Curtis D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-6cbf7ed25df09107132bec1cbce931e454f92c48829196b5d0be39441fa416e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antimicrobial agents</topic><topic>Bacterial infections</topic><topic>Clostridium difficile</topic><topic>Clostridium difficile - drug effects</topic><topic>Clostridium difficile - isolation & purification</topic><topic>Clostridium Infections - chemically induced</topic><topic>Clostridium Infections - drug therapy</topic><topic>Clostridium Infections - microbiology</topic><topic>Drug therapy</topic><topic>Drug Utilization - standards</topic><topic>Female</topic><topic>Gram-positive bacteria</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Non-Randomized Controlled Trials as Topic</topic><topic>Organizational Policy</topic><topic>Patient admissions</topic><topic>Patient Readmission</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brumley, Paul E</creatorcontrib><creatorcontrib>Malani, Anurag N</creatorcontrib><creatorcontrib>Kabara, Jared J</creatorcontrib><creatorcontrib>Pisani, Jennifer</creatorcontrib><creatorcontrib>Collins, Curtis D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of antimicrobial chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brumley, Paul E</au><au>Malani, Anurag N</au><au>Kabara, Jared J</au><au>Pisani, Jennifer</au><au>Collins, Curtis D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection</atitle><jtitle>Journal of antimicrobial chemotherapy</jtitle><addtitle>J Antimicrob Chemother</addtitle><date>2016-03</date><risdate>2016</risdate><volume>71</volume><issue>3</issue><spage>836</spage><epage>840</epage><pages>836-840</pages><issn>0305-7453</issn><eissn>1460-2091</eissn><abstract>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 < 0.001). Individual bundle components that were significantly improved in the bundle group were discontinuation of non-essential acid suppressants (90% versus 18%, P < 0.001) and administration of appropriate CDI therapy (82% versus 64%, P < 0.009). No significant differences were observed in overall or CDI-related mortality or readmissions, durations of therapy or reduction of non-essential concomitant antimicrobials.
Introduction of an antimicrobial stewardship bundle for CDI significantly improved adherence to institutional treatment recommendations and overall management of patients with CDI.</abstract><cop>England</cop><pub>Oxford Publishing Limited (England)</pub><pmid>26661392</pmid><doi>10.1093/jac/dkv404</doi><tpages>5</tpages></addata></record> |
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| identifier | ISSN: 0305-7453 |
| ispartof | Journal of antimicrobial chemotherapy, 2016-03, Vol.71 (3), p.836-840 |
| issn | 0305-7453 1460-2091 |
| language | eng |
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| source | Oxford Journals Online |
| 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 |
| title | Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection |
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