An antibiotic policy associated with reduced risk of Clostridium difficile-associated diarrhoea

Background: antibiotic-associated diarrhoea caused by Clostridium difficile is increasing in hospitals, and older people are at particular risk. Objective: to establish whether reducing patient exposure to injectable third-generation cephalosporins fry substituting alternative antibiotics can produce a cost-effective reduction in the incidence of antibiotic-associated diarrhoea. Design: we prospectively investigated 2157 patients admitted to the department of elderly medicine in the year before introduction of antibiotic restrictions and 2037 patients admitted in the following year. Patients admitted to other wards, where antibiotic prescribing was unchanged, acted as controls. Setting: a 900-bed teaching hospital in Cambridge, UK. Measurements: use and cost of injectable antibiotics prescribed in the department of elderly medicine and the other wards studied; occurrence of C. difficile-associated diarrhoea. Results: in the wards for older people, consumption of injectable cephalosporins fell by 92% (compared with 8% on other wards) and cases of C. difficile-associated diarrhoea fell from 98 to 45 (cases in other wards rose from 213 to 253; P < 0.001). The pound 8062 increase in injectable antibiotic costs on the elderly wards were offset by the release of 1087 wasted bed-days attributable to the 53 fewer cases, with potential savings of pound 212 000. Conclusions: restricting the consumption of injectable third-generation cephalosporins is a cost-effective method of reducing the incidence of C. difficile-associated diarrhoea.