Role of Antimicrobial Stewardship Programs in Decreasing Hospital-Associated Clostridium difficile Infections

Abstract

To provide a review of literature that discusses some of the most successful antimicrobial stewardship interventions reported across institutions worldwide in response to increased Clostridium difficile infection (CDI) rates. Although many different types of antimicrobial reduction practices have been proven effective, differences in resources across varying sizes of institutions may make some interventions more attainable than other. Regardless of available resources, an initial assessment of the correlation of positive laboratory tests to clinical disease is necessary to quantify the true burden of hospital-onset CDIs (HO-CDI). Infection prevention programs, in conjunction with antimicrobial reduction interventions, and the appropriate identification of patients to undergo laboratory testing, are key components of a HO-CDI reduction program. Clostridium difficile is an important cause of serious healthcare-associated infections (HAIs), causing adverse consequences for patients including, but not limited to, increased length of hospital stay, healthcare costs, and mortality. Since the early 2000s, there has been a notable increase in CDI. Antimicrobial stewardship programs (ASPs) have responded to this public health threat with a number of different strategies including antimicrobial use reduction, education, appropriate testing, and multiple other interventions. Along with providing a literature review on ASP interventions to address the CDI threat, we describe our experience in successfully reducing HO-CDI at Northwestern Memorial Hospital with the use of multiple interventions.