Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era

Abstract

Objective: Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship. Methods: Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression. Results: Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies. Conclusions: Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non–ID-trained pharmacists and clinicians in antibiotic stewardship.

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

“…an ID physician with or without an ID pharmacist [1][2][3][4][5][6]. However, approximately a quarter of US hospitals have no access to on-site ID specialists [7,8]. Hospitals without on-site ID specialists have had success reducing antibiotic use by collaborating with remote ID specialists [6,[9][10][11], but it is unclear if ID specialists are a prerequisite for effective stewardship.…”

Use of leading practices in US hospital antimicrobial stewardship programs

“…This finding is consistent with an infection preventionist survey that found hospitals frequently rejected formed stool submitted for CDI testing but that the use of urine culture stewardship was much lower. 19 …”

Coronavirus disease 2019 (COVID-19) research agenda for healthcare epidemiology

“…110,111 ASP teams are now ubiquitous in US hospitals, but ensuring that all hospitals have adequate infectious disease expertise on their teams may require novel approaches. 112 Simultaneously, the responsibilities of ASPs have increasedwith many playing an active role in COVID-19 management, such as guideline development or remdesivir allocation. 113,114 Virtual strategies, such as 'tele-stewardship' and nimble regional or national 'hotlines,' particularly for small and rural hospitals, need to be evaluated and implemented.…”