Impact of antimicrobial stewardship interventions on Clostridium difficile infection and clinical outcomes: segmented regression analyses

摘要: Background Antimicrobial exposure is associated with increased risk of Clostridium difficile infection (CDI), but the impact prescribing interventions on CDI and other outcomes less clear. Objectives To evaluate effect an antimicrobial stewardship intervention targeting high-risk antimicrobials (HRA), implemented in October 2008, to compare findings similar studies from a systematic review. Methods All patients admitted Medicine Surgery Ninewells Hospital 2006 September 2010 were included. Intervention effects HRA use (dispensed DDD), cases mortality rates, per 1000 admissions month, analysed separately using segmented regression interrupted time series (ITS) data. Data comparable published reanalysed same method. Results Six months post-intervention, there relative reductions 33% (95% CI 11-56) 32% 19-46) Surgery. At 12 months, was estimated reduction 7.0 cases/1000 [relative change -24% CI - 55 6)] Medicine, no {estimated 0.1 fewer [-2% CI - 116 112)]}. Mortality reduced throughout study period, unaffected by intervention. In all six studies, significantly, rates only statistically significant two none measured mortality. Pre-intervention trends influenced effect. Conclusions Despite large CDI, demonstrating real-world remains challenging.