Stewardship steps tied to reduced antibiotics, C diff at community hospital
Implementation of a multifaceted antimicrobial stewardship program (ASP) in a large community hospital in New Jersey was associated with significant, sustained reductions in unnecessary antibiotic use, Clostridioides difficile infection (CDI) rates, and antimicrobial acquisition costs, researchers reported late last week in Infection Control & Hospital Epidemiology.
In early 2013, the 413-bed acute care non-teaching hospital implemented two processes to address overuse of broad-spectrum intravenous antibiotics: reduction in the computerized antibiotic ordering duration from 14 days to 7 days, and a pharmacist-driven ASP that had authority to discontinue unnecessary antibiotic use. In addition, the hospital changed its CDI testing protocol in 2016 to reduce unnecessary testing.
Comparison of the baseline period (October 2012 to March 2013) to the period following implementation of the ASP showed that average antibiotic days of therapy (DOT) fell by more than 10% initially, and over the study period fell from 860 per 1,000 patient-days to 400 to 500 per 1,000 patient-days in 2021. Reductions were consistent among all antibiotic classes. No concordant rise in complications, such as increased intensive care unit admissions or 30-day sepsis readmission rates, were observed.
The hospital's CDI rate fell by more than 90%, with the most significant reduction occurring after the test protocol was changed, and antibiotic acquisition costs declined by more than 50%. The analysis also found that Pseudomonas aeruginosa susceptibilities to piperacillin and imipenem increased by statistically significant levels.
The study authors note that the findings are significant because most literature on ASPs has been published from large academic medical centers, where physicians are employed by the health system, and very little research has been published on ASPs in non-academic settings that use private practice infectious diseases physicians. They say the results indicate that antibiotic prescribing can be improved even in settings where many physicians are in private practice.
"Safely averting the administration of thousands of doses of unnecessary and potentially harmful therapeutics exemplifies high-value care," they wrote. "We believe that these results could potentially serve as a benchmark for appropriate utilization, particularly in community hospitals."
Dec 17 Infect Control Hosp Epidemiol abstract
New C diff drug substantially reduces recurrence in phase 3 trial
Summit Therapeutics, of Cambridge, Massachusetts, announced promising results today from a phase 3 trial of its investigational precision CDI drug, ridinilazole.
The results of the phase 3 Ri-CoDiFy trial, which included 759 patients at hospitals in the United States and several other countries, showed that patients treated with ridinilazole experienced substantially less recurrence of CDI compared with patients treated with vancomycin. That finding resulted in a higher sustained clinical response (SCR) for ridinilazole than for vancomycin, but the drug did not meet the study's primary end point for superiority. SCR is defined as clinical response of the treated episode of CDI and no recurrence of infection 30 days after the end of treatment.
The company says the results, which have not yet been peer-reviewed or published, were particularly promising in patients considered high-risk.
While vancomycin is the standard of care for CDI, treatment with broad-spectrum antibiotics, which eliminate both good and bad gut bacteria, can put patients at risk of recurring infections. A phase 2 study of ridinilazole showed that the drug specifically targets C difficile, sparing commensal bacteria.
"Although Ri-CoDIFy did not meet the primary endpoint for the design of this study, we did see a meaningful reduction in recurrence in the ridinilazole arm, which we believe is tied to the precision properties of ridinilazole and its associated relative sparing of the gut microbiome," Fong Clow, DSc, head of biometrics at Summit, said in a company press release. "We believe this is a viable measurement of the effect of this drug and has biological significance as to the potential value of the drug."
Dec 20 Summit Therapeutics press release