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Impact of a Diagnosis-Centered Antibiotic Stewardship on Incident Clostridioides difficile Infections in Older Inpatients: An Observational Study

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Service de Médecine Interne Gériatrie, Hôpital de Champmaillot, Centre Hospitalier Universitaire, 2 rue Jules Violle, 21079 Dijon CEDEX, France
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Service d’Epidémiologie et Hygiène Hospitalière, Centre Hospitalier Universitaire, 14 rue Paul Gaffarel, 21079 Dijon CEDEX, France
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Service de Microbiologie, Centre Hospitalier Universitaire, 14 rue Paul Gaffarel, 21079 Dijon CEDEX, France
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Author to whom correspondence should be addressed.
Antibiotics 2020, 9(6), 303; https://doi.org/10.3390/antibiotics9060303
Received: 14 May 2020 / Revised: 27 May 2020 / Accepted: 4 June 2020 / Published: 5 June 2020
(This article belongs to the Special Issue Antibiotic Resistance: From the Bench to Patients)
In 2015, a major increase in incident hospital-onset Clostridioides difficile infections (HO-CDI) in a geriatric university hospital led to the implementation of a diagnosis-centered antibiotic stewardship program (ASP). We aimed to evaluate the impact of the ASP on antibiotic consumption and on HO-CDI incidence. The intervention was the arrival of a full-time infectiologist in the acute geriatric unit in May 2015, followed by the implementation of new diagnostic procedures for infections associated with an antibiotic withdrawal policy. Between 2015 and 2018, the ASP was associated with a major reduction in diagnoses for inpatients (23% to 13% for pneumonia, 24% to 13% for urinary tract infection), while median hospital stays and mortality rates remained stable. The reduction in diagnosed bacterial infections was associated with a 45% decrease in antibiotic consumption in the acute geriatric unit. HO-CDI incidence also decreased dramatically from 1.4‰ bed-days to 0.8‰ bed-days in the geriatric rehabilitation unit. The ASP focused on reducing the overdiagnosis of bacterial infections in the acute geriatric unit was successfully associated with both a reduction in antibiotic use and a clear reduction in the incidence of HO-CDI in the geriatric rehabilitation unit. View Full-Text
Keywords: Clostridioides difficile; clostridium; stewardship; diagnostic; acute infection; antibiotic; aged Clostridioides difficile; clostridium; stewardship; diagnostic; acute infection; antibiotic; aged
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Putot, A.; Astruc, K.; Barben, J.; Mihai, A.M.; Nuss, V.; Bador, J.; Putot, S.; Dipanda, M.; Laborde, C.; Vovelle, J.; Da Silva, S.; Mazen, E.; Aho Glélé, L.S.; Manckoundia, P. Impact of a Diagnosis-Centered Antibiotic Stewardship on Incident Clostridioides difficile Infections in Older Inpatients: An Observational Study. Antibiotics 2020, 9, 303.

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