Monitoring Antibiotics Cuts Kids’ Risk Of C. Diff

Children in the hospital are three times less likely to become sick with Clostridium difficile, a serious bacterial infection, when the hospital takes part in a program designed to reduce the misuse of antibiotics.

Antibiotics disturb the balance of bacteria in the gastrointestinal system, wiping out good bacteria with the bad, allowing C. diff bacteria to multiply and cause cramps and diarrhea.

Because C. diff is an emerging infection among children, more and more hospitals are adopting antibiotic stewardship programs to ensure that the right drug is prescribed at the right time for the right diagnosis.

Saves Money and Stress

A new study shows that not only are these programs effective in reducing the rate of C. diff, they save money, as well. Says Jean Wiedeman, medical director of pediatric antimicrobial stewardship at the University of California, Davis, Children’s Hospital:

“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.

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 between the pre-antibiotic stewardship era (2008-2010) and the antibiotic stewardship era (2011-2014). The findings show that 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.

Recommended Interventions

The study analyzed the use of antibiotics prescribed to hospitalized children one to 17 years old.

The 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 include:

  • Stopping antibiotics that are unnecessary
  • De-escalating therapy by prescribing a more narrow-spectrum antibiotic than is being used
  • Adjusting the dose based on obesity, kidney, or liver dysfunction
  • Switching from intravenous to oral antibiotics
  • Changing to an equally effective and less expensive antibiotic

Cost savings arising from reduced antibiotic use were also 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.

The findings show improvement, even for antibiotics not specifically targeted by the stewardship. The authors hypothesized that this may be due to improved education of attending and resident physicians on the importance of appropriate antibiotic prescribing.