Does an antimicrobial stewardship program's interventions reduce the rate of and protect against Clostridium difficile infection?

BACKGROUND: To minimize Clostridium difficile infections (CDI) incidence which can be life-threatening, Antimicrobial Stewardship Programs (ASP) have often been recommended as a viable solution. Our study aims to evaluate whether ASP interventions have contributed to reducing CDI rates.

METHODS: A retrospective review of ASP interventions issued from January 2013 to April 2014 was performed using data from the ASP database of Singapore General Hospital (SGH), a 1600-bed tertiary-care hospital. 283 interventions satisfied our inclusion criteria, of which commonly audited antibiotics were piperacillin/tazobactam (41.34%) and carbapenems (54.77%). Comparisons were made at 30-days post-intervention between those who accepted or rejected interventions. The primary outcome was CDI incidence; secondary outcomes included 30-day mortality and recurrence rate.

RESULTS: While median duration of antibiotic therapy was reduced by 2days (6days vs. 4 days, p<0.001), acceptance of ASP interventions did not alter primary CDI incidence at 30-days (p=0.644) post-intervention. However, reduced CDI recurrence rates were observed for patients positive for CDI in the accepted patient group compared to the rejected group (0% vs. 37.5% p<0.03) with no difference in CDI 30-day mortality between the two groups.

CONCLUSION: Intervention acceptance did not contribute to a significant reduction in CDI incidence, but may be associated with lower recurrence rates, though further studies will be required.