A pressing issue within health care settings is the escalating rate of Clostridioides difficile infections (CDIs), contributing significantly to health care-associated infections (HAIs). St. Joseph Health System in Indiana launched antimicrobial stewardship programs and pharmacist-led initiatives between 2018 and 2021, systematically tackling this issue. These measures were primed to diminish both health care facility onset (HO) and community-onset (CO) health care facility-associated (HCFA) CDI cases, demonstrating the potential of clinical response to this persistent health threat.
The team, composed of antimicrobial stewardship pharmacist Laura Gillespie, clinical pharmacist Yassmeen Marzuq, medical student Anthony Thomas, and resident Dr. Connor Bunch, initiated four pharmacist-led steps to curb CDI prevalence. Activities included creating an antibiotic guidelines book, conducting β-lactam allergy education, introducing a penicillin skin testing protocol, and enhancing appropriateness in fluoroquinolone prescribing.
Their efforts resulted in a significant decrease in HO-CDIs and CO-HCFACDIs from 2018 to 2021, marking a reduction of 80% and 81%, respectively. Additionally, total fluoroquinolone use dropped by 74%, with a subsequent decrease in the hospital’s Standardized Infection Ratio (SIR) for HO-CDIs from 0.74 in 2018 to 0.25 in 2021, translating to a 66% decrease. All-cause mortality of patients with HO-CDI also fell from 6 deaths in 2018 to 2 in 2021.
C. difficile is the leading pathogen causing HAIs within the United States. Its widespread prevalence and the economic burden it presents, around $4.8 billion annually in excess costs, underscore the importance of sustainable and multifaceted interventions like those carried out by the St. Joseph Health System. The rampant misuse of broad-spectrum antimicrobials has significantly stimulated the prevalence of CDIs and, thus, devising strategies to improve antimicrobial prescription habits constitutes a principal focus of antimicrobial stewardship programs.
Antimicrobial stewardship programs aim to advance appropriate antimicrobial use, in turn, throttling CDI instances. Some of the promising initiatives incorporated by the St. Joseph Health System include employing local antibiotic guidelines, initiating β-lactam allergy education, testing for penicillin skin allergies, and reducing fluoroquinolone usage. The collaborative efforts yield a compelling model of how pharmacists’ interventions can strategically tackle CDIs, reducing infection rates, and consequently plummeting associated mortality and health care costs.