SAN DIEGO – An antibiotic stewardship program was associated with a threefold decline in Clostridium difficile infections in hospitalized children and a 20% savings in costs related to the use of antibiotics, based on a single-center study, Dr. Jean Wiedeman reported during a press briefing at an annual scientific meeting on infectious diseases.
The antibiotic stewardship program consisted of a prospective chart audit to determine if antibiotic prescribing was appropriate as well as the provision of immediate feedback to prescribing physicians. It also required prescribing physicians to obtain authorization from an on-call infectious diseases specialist prior to the use of certain restricted broad-spectrum or expensive antibiotics.
“That is an avenue of education for physicians because they can use a pager to call and ask questions about antimicrobial use,” Dr. Wiedeman commented. “We’ve found that’s one of the most well-liked components of the program.”
Examples of recommended interventions included halting use of antibiotics that were unnecessary, de-escalating therapy by prescribing a more narrow-spectrum antibiotic than what was being used; adjusting the dose based on obesity, kidney, or liver dysfunction; changing to an equally effective and less expensive antibiotic; and extending duration of the antibiotic or adding antibiotics.
Dr. Wiedeman, medical director of pediatric antimicrobial stewardship at the University of California, Davis, Medical Center, Sacramento, and study coauthor Dr. Natasha Nakra compared the rates of C. difficile and antibiotic-related costs at the 110-bed UC Davis Children’s Hospital between the pre–antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014).
Dr. Wiedeman reported that the rates of C. difficile at the hospital decreased from 9.2 per 10,000 patient days to 2.8 per 10,000 patient days, a more than threefold reduction (P = .003). In addition, the annual costs for antibiotics decreased from $277,620 to $221,590, which translated into a yearly savings of $56,030, she said in a video interview.
“We find that we have a highly acceptable program with over 90% of our physicians accepting an intervention. [The program] has expanded to the point where we are probably going to need another physician, because we’re also rounding with our intensivists, both in the pediatric ICU and in the neonatal ICU. There we help with prevention interventions such as looking at central-line catheters and Foley catheters, as well as making interventions for antimicrobial use,” she said.
IDWeek marks the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society. The researchers reported having no financial disclosures.