Active intervention by pharmacists encourages adherence to treatment bundles for Clostridium difficile infection (CDI), according to a study presented at ID Week 2016 in New Orleans, Louisiana.1 Reduced rates of infection recurrence and  hospital readmission were also seen, although these decreases were not statistically significant.

Kelsey Powell, PharmD, and colleagues from The Froedtert & the Medical College of Wisconsin in Milwaukee examined the effect of adherence to CDI treatment bundles both with and without pharmacist intervention on health outcomes. The researchers defined the treatment bundles as “collections of multiple evidence-based therapies related to a single disease state,” with a goal of improving patient outcomes.

A single-center, quasi-experimental study at Froedtert Hospital examined inpatients ≥18 years old diagnosed with CDI using the nucleic acid amplification test. Patients excluded from the study were those receiving comfort or hospice care, those who had CDI prior to admission, and those who had a prior CDI and had been treated during their hospital stay.


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Of 264 participants, 135 patients were in the pre-bundle implementation group examined between December 1, 2014, and March 3, 2015, and received no active pharmacist intervention. The second group consisted of 129 patients who received bundle treatment following active pharmacist intervention between December 1, 2015 and March 1, 2016.

The bundle intervention included oral vancomycin for patients with mild to moderate infection and oral vancomycin plus intravenous metronidazole for severe infection. Use of other antibiotics was reduced when possible, and proton pump inhibitors, H-2 receptor antagonists, and pro-motility/anti-peristaltic agents were stopped.

The researchers reported a significant increase in the number of patients being started on proper treatment following implementation of the treatment bundle vs pre-implementation (32% vs 93.8%; P <.001). All patients in both treatment groups either decreased or discontinued antibiotics, and all patients in the post-implementation group discontinued use of anti-peristaltic medications.  

Following implementation of the treatment bundle, 81.1% of patients discontinued use of pro-motility agents and 79.5% discontinued use of acid-reducing medications.

“While not statistically significant, trends toward decreased CDI recurrence and readmission within 8 weeks were identified in the post-implementation group (14.1% vs 10.9% and 5.2% vs 3.9%, respectively), Dr Powell and colleagues reported. “Pharmacist intervention significantly increased compliance with a CDI treatment bundle,” they concluded.

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Reference

  1. Powell K, Huang A, Revolinski S. Impact of pharmacist intervention on compliance with a Clostridium difficile treatment bundle. Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Poster 2122.