Reducing the incidence of Clostridioides difficile infection through educational and antimicrobial stewardship interventions

Background: infection (CDI) is highly contagious, characterized by a high recurrence rate, and poses a significant challenge in hospital infection control and healthcare economics. Objective: This study aimed to investigate the impact of educational and antimicrobial stewardship interventions targeting healthcare workers on the incidence of CDI, treatment prescription patterns, and healthcare costs. Methods: This retrospective, observational study was conducted in a single acute-care hospital. Educational and antimicrobial stewardship interventions aimed at improving CDI control and treatment were implemented among healthcare workers. These interventions included hospital-wide training sessions, revision of the Infection Control Manual, dissemination of information to individual wards, and case-specific interventions. The primary outcome was changes in CDI incidence per 10,000 patient-days, comparing the 19-month periods before and after the intervention. The secondary outcomes included changes in CDI treatment prescription rates and an economic evaluation of drug costs, hospitalization fees, and infection control-related expenses between the two periods. Results: A total of 75 developed CDI in the pre-intervention period and 40 developed in the post-intervention period. The CDI incidence decreased from 4.148 to 2.103 per 10,000 patient-days, representing a 49% reduction. Additionally, the prescription rate of metronidazole decreased, whereas that of fidaxomicin increased. Although drug costs increased, the total monthly healthcare expenditures, including hospitalization expenses, decreased by 55%. Discussion: Educational and antimicrobial stewardship interventions targeting healthcare workers effectively reduced CDI incidence and improved cost-effectiveness in hospital care.