Proactive Infection Control Decreases C. Diff Infection

Making infection prevention teams more accessible to the providers who care for patients shortly after those patients are admitted to the hospital leads to a significant decrease in Clostridium difficile infection (CDI), according to a study in the American Journal of Infection Control. Doing so helped to reinforce the efforts of antimicrobial stewardship programs (ASPs) to limit the use of fluroquinolone (FQ) and piperacillin-tazobactam (PTZ), which can lead to more C. diff infection, according to investigators with the Veterans Affairs Medical Center in Northport, New York, where the study data were gathered. The results suggest that a closer working relationship between the ASP and the infection control team pays off.

“The increase of infectious diseases consultations likely led to a decrease of prolonged or inappropriately prescribed antibiotics,” the study states. “This was a strategic goal of our ASP, to make the infectious diseases team more accessible, more ‘hands on’, as close to hospital admission as possible, in providing guidance on how, where, and when to appropriate use (or stop) antibiotics.”

Investigators looked at 21,330 total admissions (3806 in intensive care units) from March 1, 2011 to February 28, 2019. The hospital launched an ASP in 2016. Since the installation of the ASP, 4021 antibiotic requests were made, and 483 were denied. “There has been a statistically significant decrease in PTZ use between pre- and postimplementation of ASP, with the quarterly median of PTZ-days of therapy/1,000 patient days being 248 versus 146…,” the study states. “Comparing pre-and-post ASP implementation, there has been a decrease in CDI median annual rate 20 cases versus 6 P: 0.0005 and recurrent CDI total cases 26 versus 1.”

The infection prevention team consisted of an infection control nurse, 2 infectious disease full-time physicians, a pharmacist, and rotating infectious disease fellows.

“Members of the infection control team, with each new case of CDI, provided education to the relevant medical and nursing teams, reinforcing proper handwashing practices and isolation precautions,” the study states. “The infection control team monthly assesses, reviews new hospital acquired CDI cases and reports to national database within the Veterans Affairs. The ASP team reviews electronically all requests for restricted antibiotics.”

Investigators note the Veterans Affairs Medical Center in Northport’s affiliation with a university medical center, meaning that many young physicians rotate in and out of the hospital’s wards throughout the year.

“Interaction of our ASP team and residents led to important review of ASP concepts, allowed time for questions and better understanding of the goals of antimicrobial stewardship in general, thus, aiding in a lifetime style of proper antibiotic prescribing practice,” the study states.

For instance, investigators note that before the ASP, vancomycin plus PTZ was the most trusted combination for treatment of healthcare-acquired pneumonia. The ASP team, using testing data, convinced providers to stop using vancomycin.

“Equally important was the ASP team’s education against universal empiric use of PTZ for treating for healthcare-acquired pneumonia, thus providing alternative options based upon case by case review; other options included AMS [ampicillin/sulbactam] (especially for aspiration pneumonia), cefepime (if no anaerobic coverage is needed), or escalation to meropenem when pretest probability for extended spectrum beta lactamase (ESBL) producing organisms was high.”

The study concludes that “implementation of ASP in healthcare facilities can be challenging and requires a multidisciplinary approach and collaboration. One of the goals of successful ASP interventions is to achieve a decrease in hospital acquired CDI. Targeting and liming FQ and PTZ use in the hospital setting can help attain this primary ASP goal.”