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Inappropriate antibiotic use common in C. difficile
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SAN DIEGO — Inappropriate antibiotic use was common among patients prior to diagnosis of hospital-acquired Clostridium difficile, according to data presented at ID Week 2012.
“Small studies have found that anywhere from 40% to 83% of patients with C. difficile received inappropriate antibiotics preceding the infection,” Jocelyn Srigley, MD, of the department of pathology and molecular medicine at McMaster University in Ontario, Canada, said during her presentation. “By identifying inappropriate antibiotic use in the hospital, it may be possible to implement interventions to prevent C. difficile infection.”
Srigley and colleagues conducted a study of patients from two tertiary care hospitals who presented with a first episode of hospital-associated C. difficile infection between June 1, 2011 and May 31, 2012. Members of the antimicrobial stewardship teams retrospectively reviewed the use of antibiotic prescriptions for these patients within the previous 2 months. There was an intervention phase that began on Oct. 1, 2011, in which direct feedback was given to clinicians.
There were 126 episodes of C. difficile in 124 patients and 96% of these patients had received antibiotics before their diagnosis. In 73.8% of the episodes, patients had received at least one inappropriate course of antibiotics.
The researchers reviewed 456 courses of antibiotics and found that 45.2% of them were inappropriate. The most common reason for inappropriate antibiotics was incorrect diagnosis, which accounted for 56% of the cases. The most common indication for antibiotics was respiratory infection, which accounted for 28% of the antibiotic courses prescribed. Of these, 40.6% were found to be inappropriate. The most common infection for which a course of antibiotics was inappropriate was urinary tract infections: 75% of the antibiotics prescribed for this reason were inappropriate.
During the intervention phase, the researchers conducted 18 interventions. The recommendations included discontinuation of antibiotic treatment, consult with an infectious disease specialist in complicated cases, change to appropriate C. difficile treatment and change to agents with a narrower spectrum of activity.
“Real-time feedback was highly appreciated and accepted by the admitting teams,” Srigley said.
For more information:
Srigley J. #690. Presented at: ID Week 2012; Oct. 17-21, 2012; San Diego.
Disclosure: Srigley reports no relevant financial disclosures.
Perspective
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Herbert L. DuPont, MD
We have not done a good job in educating non-ID docs and lay public about proper use of antibiotics. While antibiotic stewardship programs are the right direction for hospitals, they oftentimes are too passive, hoping education will lead to improved prescribing. Education alone is a weak intervention aimed at changing prescribing practices. In England, dramatic reductions in C. difficile infection rates country-wide have occurred by limiting the use of fluoroquinolones and cephalosporins. We can learn from this that we have to be tougher when dealing with use of antibiotics by poorly-trained physicians.
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