Background According to the ECDC, there are 1 24 000 cases of Clostridium difficile infection (CDI) and 3700 attributable deaths per year in Europe. In our hospital, an antimicrobial stewardship programme (ASP) was implemented in 2015 with a multidisciplinary team. This preliminary study showed that only 23% of the prescriptions were initially in agreement with the international recommendations. A 30% rate of CDI relapse was observed.
Purpose The aim of this study was to evaluate the acculturation of prescribers to recommendations on the management of CDI 2 years’ after an ASP.
Material and methods From November 2017 to September 2018 an observational study was held in a 1500-bed university hospital. Analysis by the pharmacy of all prescriptions as well as criteria of severity and risk factors of recurrence, were extracted from patients’ files and biological laboratory results. In the case of non-compliance with the recommendations of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), pharmacists intervened within 24 hours after the availability of laboratory results. Ten-day and 8 week follow-up of all patients was implemented to evaluate the recovery and relapse rate.
Results Fifty-one patients were included during this period (median age 59 years; sex ratio M/F=0.88). According to the ESCMID criteria, 78.5% of patients had risk factors of recurrence of those 66.6% of severe comorbidity and 23.5% of immunosuppression. 13.7% of cases had criteria of severity with 25.3% of death at 2 months. Risk factors of recurrence included in 49% of cases antibiotic therapies, 41.2% of proton pump inhibitors and 21.6% of transit inhibitors. This study also shows that 70.6% of prescriptions agreed with the ESCMID recommendations. Fourteen pharmaceutical interventions were realised and revealed 93% prescriber acceptance. Patient follow-up showed 95% of recovery at 10 days and 15% of relapse.
Conclusion This study shows an acculturation of prescribers to recommendations even long after the realisation of ASP. These actions made it possible to reach a good recovery rate and reduce the relapse rate. The multidisciplinary approach and the direct follow-up of prescribers by the pharmacy team is necessary to the success of good management of CDI.
References and/or acknowledgements No conflict of interest.
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