title: Effect of an antimicrobial stewardship intervention on outcomes for patients with Clostridium difficile infection.
abstract: Although antimicrobial stewardship programs (ASPs) are uniquely positioned to improve treatment of Clostridium difficile infection (CDI) through targeted interventions, studies to date have not rigorously evaluated the influence of ASP involvement on clinical outcomes attributed to CDI.
  
  
  
  We performed a quasiexperimental study of adult patients with CDI before (n = 307) and after (n = 285) a real-time ASP review was initiated. In the intervention group, an ASP pharmacist was notified of positive CDI results and consulted with the care team to initiate optimal therapy, minimize concomitant antibiotic and acid-suppressive therapy, and recommend surgical/infectious diseases consultation in complicated cases. The primary outcome was a composite of attributable 30-day mortality, intensive care unit admission, colectomy/ileostomy, and recurrence.
  
  
  
  A higher percentage of patients in the ASP intervention group had acid-suppressive therapy discontinued (30% vs 13%; P < .01). Among patients with severe CDI, more patients in the intervention group received an infectious diseases consultation (17% vs 10%; P = .04), received appropriate therapy with oral vancomycin (87% vs 59%; P <.01), and vancomycin was initiated earlier (mean, 1.1 vs 1.7 days; P <.01). Incidence of the composite outcome was not significantly different between the 2 groups (12.3% vs 14.7%; P = .40).
  
  
  
  ASP review and intervention improved CDI process measures. A decrease in composite outcomes was not found, which may be due to low baseline rates of attributable complications in our institution.
authors: College of Pharmacy, University of Michigan, Ann Arbor, MI.
authors: Hanna K
authors: HK
authors: Welch
authors: Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI.
authors: Jerod L
authors: JL
authors: Nagel
authors: Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI.
authors: Twisha S
authors: TS
authors: Patel
authors: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI.
authors: Tejal N
authors: TN
authors: Gandhi
authors: Office of Performance Assessment and Clinical Effectiveness, University of Michigan Health System, Ann Arbor, MI.
authors: Benrong
authors: B
authors: Chen
authors: College of Pharmacy, University of Michigan, Ann Arbor, MI.
authors: John
authors: J
authors: De Leon
authors: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI.
authors: Carol E
authors: CE
authors: Chenoweth
authors: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI; Department of Infection Prevention and Epidemiology, University of Michigan Health System, Ann Arbor, MI.
authors: Laraine L
authors: LL
authors: Washer
authors: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI; Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
authors: Krishna
authors: K
authors: Rao
authors: College of Pharmacy, University of Michigan, Ann Arbor, MI; Department of Pharmacy, University of Michigan Health System, Ann Arbor, MI. Electronic address: gregorye@med.umich.edu.
authors: Gregory A
authors: GA
authors: Eschenauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D004358:Drug Therapy / Q000592:standards*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D065228:Non-Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Colitis; Oral vancomycin; Proton pump inhibitors