The Impact of Infectious Disease Consults on C diff and Antibiotic Stewardship

Even when mandatory infectious disease (ID) consultations lead to decreased days of therapy per 1000 patient-days, hospital-acquired Clostridiodes difficile infection (HO-CDI) rates only decreased at 1 hospital, according to a poster presented during IDWeek 2019.

Investigators from Jefferson Health New Jersey (formerly Kennedy Health) conducted a retrospective analysis across 3 hospitals between 2014 and 2017 in order to examine the impact of mandatory ID consults on HO-CDI infections, as well as the impact on utilization of antibiotics. There were 196 beds in the Jefferson-Cherry Hill hospital (CH), 181 in the Jefferson-Stratford Hospital (ST), and 230 in the Jefferson-Washington Township Hospital (WT), the study authors noted.

“At our hospital, the medical executive board passed a requirement for all adult patients with the diagnoses of sepsis, severe sepsis, septic shock, CDI, and any patient on 3 or more antibiotics — they all were required to be seen by infectious diseases preventionists,” study author Cindy Hou, DO, the Infection Control Officer at Jefferson Health and an infectious diseases specialist with Jefferson Medical Group, told Contagion®. “The goal was for patient safety, to increase appropriateness of antibiotics, as well as to reduce total antibiotic use — as antibiotics in general are a risk factor for CDI.”

The decision from the medical board came in March 2016, so the investigators analyzed the period before and after the new system was implemented. They tracked the total number of ID consults, the total HO-CDI cases at each hospital and the rate of HO-CDI, and antibiotic use for each patient.

Higher numbers of ID consults led to decreased antibiotic use for patients and reduced days of antibiotic therapy, the investigators found. This correlation was strongest at WT, though it was also observed moderately at CH and ST.

“The total number of ID consults increasing reduced overall antibiotic use,” Hou added. “This implies that more appropriate antibiotic use is occurring, which is helpful to our individual patients and to the community as a whole. This could change physician practice because hospitals could consider consults to infectious disease as a strategy to supplement and enhance their [antimicrobial stewardship programs].”

The investigators compared ID consults against HO-CDI rates and learned that the WT site was the only hospital to have ID consults strongly correlate to reduced HD-CDI, they said. There was no correlation found at CH or ST for ID consults in relation to decreased rates of HO-CDI.

“Even though antibiotic use decreased at all 3 of our hospitals, only 1 hospital had a statistically significant reduction in HO-CDI,” Hou said. “This just goes to show that there are many reasons that go into how CDI can be prevented. For example, it is important to have systems in place for infection control, hand hygiene, and care of the environment as well as to have patient education.”

The abstract, “Strategy of Mandatory Infectious Disease Consultations on Hospital-Acquired Clostridium difficile Infection and Antimicrobial Utilization,” was presented in a poster session at IDWeek 2019 in Washington DC.