Abstract
BackgroundAntibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI). Both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and PPIs among hospitalized patients.MethodsConsecutive patients admitted to two General Internal Medicine wards from October 1, 2010 until March 31, 2013 at a teaching hospital in Toronto, Ontario, Canada were evaluated. The baseline observation period was followed by the first phase, which involved the creation of a computerized order entry alert that was triggered when either a PPI or an antibiotic was ordered in the presence of the other. The second phase consisted of the introduction of an antibiotic stewardship-initiated prospective audit and feedback strategy. The primary outcome was the co-administration of antibiotics and PPIs during each phase.ResultsThis alert led to a significant reduction in the co-administration of antibiotics and PPIs adjusted for month and secular trends, expressed as days of therapy per 100 patient days (4.99 vs. 3.14, p < 0.001) The subsequent introduction of the antibiotic stewardship program further reduced the co-administration (3.14 vs. 1.80, p <0.001). No change was observed in adjusted monthly CDI rates per 100 patient care days between the baseline and alert cohorts (0.12 vs. 0.12, p = 0.99) or the baseline and antibiotic stewardship phases (0.12 vs. 0.13, p = 0.97).ConclusionsDecreasing the co-administration of PPIs and antibiotics can be achieved using a simple automatic alert followed by prospective audit and feedback.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1679-8) contains supplementary material, which is available to authorized users.
Highlights
Antibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI)
PPIs increase the risk of Clostridium difficile infection (CDI), including both incident episodes as well as recurrences, by approximately 60 % [3, 4]
Extending the purview of antibiotic stewardship programs (ASP), which are successful in lowering antibiotic use in the acute care setting, to identify medications with the potential to increase the harms of antibiotics is another potential intervention to limit co-administration [12]
Summary
Antibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI). Both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and PPIs among hospitalized patients. PPIs increase the risk of Clostridium difficile infection (CDI), including both incident episodes as well as recurrences, by approximately 60 % [3, 4] This elevated risk exists irrespective of Automated alerts activated at the time of computer order entry (CPOE) have been used to reduce medical errors through warnings of impending drug-drug interactions and unrecognized drug allergies. Similar interventions have successfully altered PPI prescribing patterns in the hospital setting and changed antibiotic. Extending the purview of antibiotic stewardship programs (ASP), which are successful in lowering antibiotic use in the acute care setting, to identify medications with the potential to increase the harms of antibiotics is another potential intervention to limit co-administration [12]
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