08:24pm Friday 18 August 2017

UC Davis study finds antibiotic stewardship reduces C. diff in hospitalized children

Jean Wiedeman Jean Wiedeman

Antibiotics disturb the balance of bacteria in the gastrointestinal system, wiping out good bacteria and allowing the C. diff bacteria to multiply and cause cramps and diarrhea. C. diff is an emerging infection among hospitalized children. Antibiotic stewardship programs led by infectious diseases (ID) specialists are increasingly being established within hospitals to reduce antibiotic misuse by ensuring that the right drug is prescribed at the right time for the right diagnosis. The IDWeek study shows these programs can save money and improve care by reducing the rate of C. diff in children more than three-fold.

C. diff infection is not always benign and can result in significant consequences for a child, including longer hospital stays, treatment with unpleasant-tasting and expensive medicines, and weight loss,” said Jean Wiedeman, an author of the study and medical director of pediatric antimicrobial stewardship at UC Davis Children’s Hospital. “It’s also stressful for parents because even after release from the hospital, their children don’t feel well and have to stay out of school and day care while they have symptoms.”

Researchers compared rates of C. diff and antibiotic-related costs at UC Davis Children’s Hospital between the pre-antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014). They found the rates of C. diff decreased from 9.2 to 2.8 per 10,000 patient days after the antibiotic stewardship program was instituted, a greater than three-fold reduction.

Cost savings arising from reduced antibiotic use were evaluated. When examining the 16 antibiotics most frequently targeted by the antibiotic stewardship program, annual costs decreased from $164,112 to $120,540 (savings of $43,572).  When all antibiotics were evaluated, annual costs decreased from $277,620 to $221,580 for a total savings of $56,040, suggesting that antibiotic prescribing overall was improved, even for antibiotics not specifically targeted by the stewardship efforts. The authors hypothesized that this may be due to improved education of attending and resident physicians on the importance of appropriate antibiotic prescribing.

The UC Davis Children’s Hospital antibiotic stewardship program reduced antibiotic misuse by reviewing antibiotic use in all children in the children’s hospital three times a week and recommending changes to therapy when indicated. Recommended interventions included: stopping antibiotics that were unnecessary; de-escalating therapy by prescribing a more narrow-spectrum antibiotic than was being used; adjusting the dose based on obesity, kidney or liver dysfunction;  switching from intraveous to oral antibiotics; and changing to an equally effective and less expensive antibiotic.  The study analyzed the use of antibiotics prescribed to hospitalized children one to 17 years old.

The study was co-authored by Natasha Nakra, of UC Davis Children’s Hospital.

IDWeek 2015TM is the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS). With the theme “Advancing Science, Improving Care,” IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. IDWeek 2015 takes place October 7-11 at the San Diego Convention Center in San Diego. For more information, visit www.idweek.org.

UC Davis Children’s Hospital is the Sacramento region’s only nationally ranked, comprehensive hospital for children, serving infants, children, adolescents and young adults with primary, subspecialty and critical care. It includes the Central Valley’s only pediatric emergency department and Level I pediatric trauma center, which offers the highest level of care for critically ill children. The 120-bed children’s hospital includes the state-of-the-art 49-bed neonatal and 24-bed pediatric intensive care and pediatric cardiac intensive care units. With more than 120 physicians in more than 30 subspecialties, UC Davis Children’s Hospital has more than 74,000 clinic and hospital visits and 13,000 emergency department visits each year. For more information, visit children.ucdavis.edu.

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