title: An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea.
abstract: BACKGROUND
  antibiotic-associated diarrhoea caused by Clostridium difficile is increasing in hospitals, and older people are at particular risk.
  
  
  OBJECTIVE
  to establish whether reducing patient exposure to injectable third-generation cephalosporins by substituting alternative antibiotics can produce a cost-effective reduction in the incidence of antibiotic-associated diarrhoea.
  
  
  METHODS
  we prospectively investigated 2157 patients admitted to the department of elderly medicine in the year before introduction of antibiotic restrictions and 2037 patients admitted in the following year. Patients admitted to other wards, where antibiotic prescribing was unchanged, acted as controls.
  
  
  METHODS
  a 900-bed teaching hospital in Cambridge, UK.
  
  
  METHODS
  use and cost of injectable antibiotics prescribed in the department of elderly medicine and the other wards studied; occurrence of C. difficile-associated diarrhoea.
  
  
  RESULTS
  in the wards for older people, consumption of injectable cephalosporins fell by 92% (compared with 8% on other wards) and cases of C. difficile-associated diarrhoea fell from 98 to 45 (cases in other wards rose from 213 to 253; P < 0.001). The Pound Sterling 8062 increase in injectable antibiotic costs on the elderly wards were offset by the release of 1087 wasted bed-days attributable to the 53 fewer cases, with potential savings of Pound Sterling 212,000.
  
  
  CONCLUSIONS
  restricting the consumption of injectable third-generation cephalosporins is a cost-effective method of reducing the incidence of C. difficile-associated diarrhoea.
authors.affiliation: Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK. hugo.ludlam@msexc.addenbrookes.anglox.nhs.uk
authors.forename: H
authors.initials: H
authors.lastname: Ludlam
authors.forename: N
authors.initials: N
authors.lastname: Brown
authors.forename: O
authors.initials: O
authors.lastname: Sule
authors.forename: C
authors.initials: C
authors.lastname: Redpath
authors.forename: N
authors.initials: N
authors.lastname: Coni
authors.forename: G
authors.initials: G
authors.lastname: Owen
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D016360:Clostridioides difficile / Q000187:drug effects; D003363:Cost Control; D003428:Cross Infection / Q000139:chemically induced* / Q000191:economics / Q000517:prevention & control; D004363:Drug Utilization / Q000191:economics; D004761:Enterocolitis, Pseudomembranous / Q000139:chemically induced* / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007267:Injections; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins