516. Implementation of a Probiotic for the Primary Prevention of Hospital-Onset Clostridium difficile Infection

Abstract

BackgroundHospital-onset Clostridium difficile infection (HO-CDI) affects over 100,000 patients in the United States each year. Due to a rising rate of HO-CDI at Denver Health, a multifaceted CDI prevention plan was implemented which included a probiotic intervention. The purpose of this study was to describe the implementation and uptake of the probiotic intervention.MethodsThis is a retrospective study of adult inpatients who received antibiotics considered high-risk for the development of CDI from March 2017 to March 2018. In March 2017, a Best Practice Advisory (BPA) was implemented to advise providers to order Bio-K+ (L. acidophilus, L. casei, and L. rhamnosus) when they signed an order for a high-risk antibiotic. The BPA allowed providers to order or decline the probiotic directly from the BPA. The BPA was suppressed in patients who were pregnant, immunocompromised, unable to take oral medications, or had active CDI. The primary outcome was the proportion of patients for whom Bio-K+ was prescribed in the first year. Secondary outcomes include CDI rates before and after the intervention and adverse events defined as a positive Lactobacillus culture.ResultsThe BPA fired in 3,840 cases, and Bio-K+ was ordered in 94.8% of these. For patients who received a high-risk antibiotic for at least 24 hours, there were 2,636 courses of Bio-K+ prescribed for 2,324 unique patients for a median duration of 3 days. The HO-CDI rates for 1 year pre- and postintervention were 0.75 and 0.60 cases per 1,000 patient days, respectively (P = 0.16). Lactobacillus was cultured in 11 patients; five patients received Bio-K+ prior to culture. The positive cultures were from abdominal fluid (4) and sputum (1). There were no positive blood cultures in patients who received the probiotic.ConclusionA probiotic intervention for the prevention of CDI implemented via BPA had excellent provider uptake. As part of a multifaceted CDI action plan, a probiotic intervention was well received and had a low risk of serious adverse events.Figure 1.Table 1. N = 2,636 courses of Bio-K+Male, n (%)1,517 (58)Age, mean54Length of stay, median days (IQR)5 (3–9)Days of Bio-K+, median (IQR)3 (2–6)Courses of high-risk antibiotics Ceftriaxone1,185 Cefepime516 Piperacillin/tazobactam279 Ampicillin/sulbactam260 Clindamycin250 Levofloxacin217 Other176Figure 2.Disclosures All authors: No reported disclosures.