단일 3차 의료기관의 성인 Clostridioides difficile 감염(CDI)에 영향을 미치는 위험인자 분석 및 약물사용 평가
Analysis of Risk Factors and Evaluation of Medication Use Affecting Clostridioides Difficile Infections (CDIs) in Adults in a Single Tertiary Hospital
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Background : Clostridioides difficile infections (CDIs) are one of the most common nosocomial infections, representing a significant global health issue. The Society for Healthcare Epidemiology of America/Infectious Disease Society of America 2017 guidelines recommend using oral vancomycin and fidaxomicin to treat CDIs. The effectiveness of antibiotic stewardship programs (ASPs) in reducing inappropriate antibiotic use and facilitating optimal antibiotic use to reduce the occurrence of CDI was investigated. This study aimed to establish a foundation for ASPs to promote optimal antibiotic use in CDI patients. Methods : We analyzed adult patients aged 18 years and older who were on contact precautions for CDI between January 2019 and December 2022, using data extracted from electronic medical records. We analyzed the risk factors for the occurrence and severity of CDIs and evaluated the appropriateness of medication use. Results : CDI incidence was significantly higher among adults aged 75 years and above (p=0.005), patients who used proton pump inhibitors (p<0.001), patients with comorbidities (p<0.001), and patients treated in the intensive care unit (p<0.001). The use of third-generation cephalosporins was more common in the severe infection group (p=0.013), whereas carbapenem and glycopeptide use was significantly more common in the fulminant group (p<0.001). The use of oral drugs complied with the guidelines in 1,068 cases (68.7%), and the percentage of cases with appropriate dosage and duration of oral drug use was 24.6%, 3.1%, and 18.2% in the non-severe, severe, and fulminant groups, respectively. Conclusion : For the successful implementation of an ASP, continuous interest and support are needed for dedicated pharmacist activities to monitor CDI patients and facilitate appropriate antibiotic use.
Abstract
Background : Clostridioides difficile infections (CDIs) are one of the most common nosocomial infections, representing a significant global health issue. The Society for Healthcare Epidemiology of America/Infectious Disease Society of America 2017 guidelines recommend using oral vancomycin and fidaxomicin to treat CDIs. The effectiveness of antibiotic stewardship programs (ASPs) in reducing inappropriate antibiotic use and facilitating optimal antibiotic use to reduce the occurrence of CDI was investigated. This study aimed to establish a foundation for ASPs to promote optimal antibiotic use in CDI patients. Methods : We analyzed adult patients aged 18 years and older who were on contact precautions for CDI between January 2019 and December 2022, using data extracted from electronic medical records. We analyzed the risk factors for the occurrence and severity of CDIs and evaluated the appropriateness of medication use. Results : CDI incidence was significantly higher among adults aged 75 years and above (p=0.005), patients who used proton pump inhibitors (p<0.001), patients with comorbidities (p<0.001), and patients treated in the intensive care unit (p<0.001). The use of third-generation cephalosporins was more common in the severe infection group (p=0.013), whereas carbapenem and glycopeptide use was significantly more common in the fulminant group (p<0.001). The use of oral drugs complied with the guidelines in 1,068 cases (68.7%), and the percentage of cases with appropriate dosage and duration of oral drug use was 24.6%, 3.1%, and 18.2% in the non-severe, severe, and fulminant groups, respectively. Conclusion : For the successful implementation of an ASP, continuous interest and support are needed for dedicated pharmacist activities to monitor CDI patients and facilitate appropriate antibiotic use.
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