title: Antimicrobial stewardship programs that target only high-cost, broad-spectrum antimicrobials miss opportunities to reduce Clostridium difficile infections.
abstract: Antimicrobial stewardship programs are promoted as a strategy to reduce Clostridium difficile infections. We implemented an antimicrobial stewardship program comprised of formulary restriction plus prospective audit with feedback for high-cost and broad-spectrum antimicrobials. Subsequently, we reviewed all heath care facility-onset, health care facility-associated C difficile infections. We found that most of these infections were associated with the antecedent receipt of nonaudited, and often unnecessary, antimicrobials.
authors.affiliation: Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Christine
authors.initials: C
authors.lastname: Bui
authors.affiliation: Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Zhu
authors.affiliation: Department of Pharmacy, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Donnelley
authors.affiliation: Division of Biostatistics, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Machelle D
authors.initials: MD
authors.lastname: Wilson
authors.affiliation: Department of Hospital Epidemiology and Infection Prevention, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Morita
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, CA.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Cohen
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of California, Davis Medical Center, Sacramento, CA. Electronic address: jzbrown@ucdavis.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000517:prevention & control*; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial stewardship; Clostridium difficile