A comparative evaluation of toxigenic Clostridioides difficile prevalence as a metric of hospital antibiotic stewardship in Saudi Arabia

Abstract

Background
Clostridioides difficile infection (CDI) is caused by toxigenic strains of C. difficile a Gram positive, antibiotic resistant anaerobic bacillus. Reports suggest that CDI and associated risk factors including inappropriate exposure to antibiotics, are common in Saudi Arabia. The aim of this study was to assess the impact of antibiotic stewardship on the prevalence of toxigenic C. difficile (tCd) among inpatients at Johns Hopkins Aramco Healthcare in Saudi Arabia and evaluate the utility of tCd prevalence as a patient outcome metric of antibiotic stewardship.

Methods
A retrospective review of laboratory data was conducted to identify patients testing positive for toxigenic C. difficile over the study period. The prevalence of tCd among inpatients tested pre and post implementation of the antibiotic stewardship program, was compared to assess the impact of the program.

Result
A significant reduction in tCd prevalence was observed following the implementation of the antibiotic stewardship program.

Conclusion
The prevalence of toxigenic C. difficile can be used as a simple and sensitive metric of the impact of hospital antibiotic stewardship on CDI. Formulary restriction of high CDI risk antibiotics and bundling of antibiotic prescribing and infection control interventions will strengthen the impact of antibiotic stewardship in reducing tCd prevalence in the hospital.

Date of Award	2020
Original language	English
Awarding Institution	University of Bath
Supervisor	Albert Bolhuis (Supervisor)