It has been reported that there has been an increase of Clostridioides difficile infections (CDIs) nationally, but that our Trust is an outlier in the increase of both Community Onset Healthcare Associated (COHA) and Healthcare Onset Healthcare Associated (HOHA). Within the financial year 2023/24 there was a total of 97 CDI cases, that’s 48 cases over our Trusts limit (almost 50% over threshold). 61 were available to analyse at the time of data collection.

 

This was a retrospective quantitative study that holistically analyses adherence to antimicrobial stewardship (AMS) standards, and appropriate review of proton pump inhibitors (PPIs) and laxatives in patients identified as CDI toxin positive. Antibiotic history was considered, therefore leading to a comparison of both primary and secondary care practices.

 

Contributing factors affecting CDI that were considered:

• Total antibiotic course length

• Percentage of antibiotics >7 days

• Indications commonly associated with antibiotics prescribed >7 days

• Percentage of CDI positive patients associated with narrow spectrum vs broad spectrum antibiotic prescribing

• Reasons that escalate CDI positive patient cases to require a full post infection review (PIR)

• If PIR was required, what were the reasons driving this and what percentage were CDI relapse or recurrence

 

From this analysis we explored the rationale for certain actions taken by the WSH AMS team, including changing all fidaxomicin to the EXTEND protocol (with EPMA considerations), updating education and training, reaching out to advanced care practitioners, and considering the necessity of a CDI multidisciplinary team ward round.