Aggressive campaign to cut unnecessary use of antibiotics helps reduce drug-resistant bacteria

An aggressive campaign to reduce the unnecessary use of antibiotics has helped cut the rate of infection with a dangerous drug-resistant bacteria at The Valley Hospital by nearly 40 percent.

Clostridium difficile, or C.diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. A recent article in the New England Journal of Medicine article "Burden of Clostridium difficile Infection in the United States" asserts that "C. difficile was responsible for almost half a million infections and was associated with approximately 29,000 deaths in 2011."

The article looked at C. diff infections in health care settings and in the communities of 10 geographic areas. According to the study, "A total of 15,461 cases of C. difficile infection were identified in the 10 geographic areas; 65.8 percent were health care-associated, but only 24.2 percent had onset during hospitalization." The study found that of the 293,300 health care-associated cases, roughly 107,600 originated in the hospital, 104,400 originated in a nursing home and 81,300 had a community onset that was associated with having received outpatient care at a health care facility.

Reducing the spread of C.diff will depend on strict adherence to recognized infection control strategies, including hand washing, sterilization of surfaces and equipment, and isolation when appropriate. But C. diff is also becoming more prevalent because of the widespread of overuse of antibiotics. While the choice of whether an antibiotic is needed and which one should be used is ultimately a decision to be made by the doctor and patient, it is clear that hospitals have an important role to play in helping doctors and patients make wise choices.

"The overuse of antibiotics predisposes people to infection with C.diff and other antibiotic-resistant organisms," said Neil Gaffin, M.D., an infectious disease specialist at Valley.

To address the link between the overuse of antibiotics and the rate of C.diff infections, in the spring of 2013 The Valley Hospital launched an aggressive antibiotic stewardship program to supplement the hospital's comprehensive environmental disinfection program. Dr. Gaffin's write-up of Valley's antibiotic stewardship program will be published in a forthcoming issue of Clinical Infectious Diseases, a leading journal in the field of infectious disease.

"The over-arching goal is to increase patient safety by reducing the use of unnecessary antibiotics," Dr. Gaffin said. "Overuse of antimicrobials causes patient harm mainly by predisposing patients to C.diff infection and contributing significantly to the emergence of drug-resistant bacteria, which can be harder to treat."

"Our antibiotic stewardship programs works in synchrony with our environmental disinfection program by reducing the amount of drug-resistant organisms -- the bio burden, if you will -- in the hospital," he said.

"At Valley we are very aggressive about limiting antibiotics, restricting their use as much as possible to those patients who really need them," Dr. Gaffin said. "As a result, we've significantly reduced the indiscriminate use of IV antibiotics and our rate of C.diff has declined."

To date, thanks to the antibiotic stewardship program coupled with comprehensive environmental cleaning and disinfection, C.diff rates at Valley have dropped by nearly 40 percent in 2014, compared to 2013, according to Dr. Gaffin.

"I'm very proud of our program," Dr. Gaffin said. "No one is monitoring antibiotic use more aggressively than we are here at The Valley Hospital."