Effect of Leadership Commitment and Education on Antimicrobial Use and Hospital-Acquired Clostridium difficile infection rates at a Community Hospital

BACKGROUND: Antimicrobial stewardship is critical to optimizing the treatment of infections and reducing the adverse events associated with antimicrobial use including Clostridium difficile infection. National public health and quality organizations have identified a number of core elements of successful hospital antimicrobial stewardship programs, including leadership commitment and education. This study was conducted at a 350-bed community teaching hospital with an established antimicrobial stewardship program. The purpose of this study was to identify the impact of leadership commitment and education on antimicrobial use and hospital-acquired Clostridium difficile at a community hospital. METHODS: This was a pre- and post-intervention cohort study. Hospital leadership demonstrated commitment to antimicrobial stewardship through the addition of the Vice President of the Department of Medicine as well as additional clinical pharmacy support to the Antimicrobial Stewardship team. Education was provided to staff in the form of competencies for physicians, pharmacists and nurses, as well as didactic lectures and resources available on the internal antimicrobial stewardship website. Data were collected for one-year pre- and post-intervention periods, calendar year 2015 and 2016, respectively. Antimicrobial use was measured as defined daily doses (DDDs) per 1000 patient-days. RESULTS: Compliance with antimicrobial stewardship competencies was 14% (107/759) for physicians, 74% (26/35) for pharmacists and 89% (588/658) for nurses. Antimicrobial use in the post-intervention period was 518.14 DDDs per 1000 patient-days compared with 558.99 DDDs per 1000 patient-days in the pre-intervention period. This was a decrease of 7.3% (CI 6.15-8.44, P < 0.001). The hospital-acquired Clostridium difficile infection rate decreased from 5.22 cases per 10,000 patient-days in the pre-intervention period to 3.81 cases per 10,000 patient-days in the post-intervention period, a decrease of 27% (CI -19.4-55.6, P = 0.21). CONCLUSION: Antimicrobial stewardship program expansion in the areas of leadership commitment and education was associated with a 7% decrease in antibiotic use. This was associated with a non-statistically significant decrease in the rate of hospital-acquired Clostridium difficile infection. DISCLOSURES: All authors: No reported disclosures.