SAN DIEGO – Hospitalized children were three times less likely to become sick with Clostridium difficile, following implementation of an antibiotic stewardship program, according to a study being presented at IDWeek 2015. 

“By applying antimicrobial stewardship with a multipronged approach, we have been able to improve the rate of C. difficile three-fold.” Jean Wiedeman, MD, PhD, an author of the study and medical director of pediatric antimicrobial stewardship at the University of California Davis Medical Center, Sacramento said during a press event about the study.  

The researchers compared rates of C. difficile and antibiotic-related costs at UC Davis Children’s Hospital between the pre-antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014). They found the rates of C. diff decreased from 9.2 to 2.8 per 10,000 patient days after the antibiotic stewardship program was instituted, a greater than three-fold reduction. Cost savings arising from decreased antibiotic use following institution of the stewardship program were calculated. 


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When all antibiotics were evaluated, annual costs decreased from $277,620 to $221,590 for a total yearly savings of $56,030. The physician-led stewardship program utilized two methods: (1) prospectively auditing charts of hospitalized patients to determine if antimicrobial prescribing was appropriate and providing immediate (real time) feedback to prescribing physicians and (2) requiring prescribers to obtain authorization from an infectious disease specialist prior to the use of certain restricted broad-spectrum or expensive antibiotics. 

The researchers noted that both methods contributed to the antibiotic cost savings. 

The UC Davis Children’s Hospital antibiotic stewardship program reduced antibiotic misuse by reviewing antibiotic use in all children in the 110-bed hospital three times a week. Recommended interventions included: stopping antibiotics that were unnecessary; de-escalating therapy by prescribing a more narrow-spectrum antibiotic than was being used; adjusting the dose based on obesity, kidney or liver dysfunction; switching from intraveous to oral antibiotics; changing to an equally effective and less expensive antibiotic; and sometimes extending duration of the antibiotic or adding additional antimicrobials. 

Additionally, a pediatric infectious disease specialist was available every day of the week to authorize use of restricted antibiotics. The study analyzed the use of antibiotics prescribed to hospitalized children 1 to 17 years old.

During the press event, Dr Wiedeman noted that it is harder for smaller hospitals to get access to a stewardship, but researchers are hopeful that their results will encourage implementation for more stewardship programs in the future.

Reference

1. Nakra N, Wiedeman J. Abstract 1468. Antimicrobial Cost Savings and Reduction in Clostridium Difficile Infection Rates Following Implementation of a Pediatric Antimicrobial Stewardship Program. Presented at: ID Week 2015. Oct. 7-11, 2015. San Diego.