title: Effect of an antimicrobial stewardship bundle for patients with Clostridium difficile infection.
abstract: OBJECTIVE
  The study objective was to determine whether there was an improvement in compliance with recommended Clostridium difficile infection (CDI) treatment after introduction of an institutional CDI bundle with daily antimicrobial stewardship assessment.
  
  
  METHODS
  This was a single-centre, quasi-experimental study evaluating compliance with an antimicrobial stewardship team-implemented care bundle in patients with CDI compared with historical controls. The primary outcome, compliance with overall bundle elements, was achieved when the following measures were accomplished: (i) appropriate CDI antimicrobial therapy based on the institutional treatment algorithm; (ii) discontinuation of acid-suppressant therapy in the absence of a pre-specified indication; and (iii) discontinuation of unnecessary antimicrobials. Secondary objectives were to evaluate the extent to which antimicrobial stewardship involvement affected treatment compliance and to assess trends in CDI clinical outcomes, such as mortality and readmission.
  
  
  RESULTS
  One-hundred-and-sixty-nine patients were evaluated; 83 after implementation of the care bundle (bundle group) and 89 prior to bundle implementation (historical control group). Compliance with overall bundle endpoints was significantly higher in the bundle group versus the control group (81% versus 45%, P < 0.001). Individual bundle components that were significantly improved in the bundle group were discontinuation of non-essential acid suppressants (90% versus 18%, P < 0.001) and administration of appropriate CDI therapy (82% versus 64%, P < 0.009). No significant differences were observed in overall or CDI-related mortality or readmissions, durations of therapy or reduction of non-essential concomitant antimicrobials.
  
  
  CONCLUSIONS
  Introduction of an antimicrobial stewardship bundle for CDI significantly improved adherence to institutional treatment recommendations and overall management of patients with CDI.
authors.affiliation: Department of Pharmacy Services, St. Joseph Mercy Health System, 5301 East Huron River Drive, Ann Arbor, MI, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Brumley
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, St. Joseph Mercy Health System, 5301 East Huron River Drive, Ann Arbor, MI, USA Department of Infection Prevention and Control, St. Joseph Mercy Health System, 5301 East Huron River Drive, Ann Arbor, Michigan, USA.
authors.forename: Anurag N
authors.initials: AN
authors.lastname: Malani
authors.affiliation: Quality Institute, St. Joseph Mercy Health System, 5301 East Huron River Drive, Ann Arbor, MI, USA.
authors.forename: Jared J
authors.initials: JJ
authors.lastname: Kabara
authors.affiliation: University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pisani
authors.affiliation: Department of Pharmacy Services, St. Joseph Mercy Health System, 5301 East Huron River Drive, Ann Arbor, MI, USA curtis.collins@stjoeshealth.org.
authors.forename: Curtis D
authors.initials: CD
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D016134:Organizational Policy; D010359:Patient Readmission; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents