JHQ 4822: Reducing Community Acquired CDIFF Admissions: Outpatient Antimicrobial Stewardship-JHQ 4822 C-Diff Article

JHQ 4822 C-Diff Article

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This article describes a 2024 outpatient antimicrobial stewardship program designed to reduce community-acquired Clostridioides difficile (C. difficile) hospital admissions by improving antibiotic prescribing for common respiratory conditions. Because the CDC estimates that 80%–90% of antibiotic use occurs in outpatients and at least 30% is unnecessary, the institution created a multidisciplinary team (infection preventionist, pharmacist, and infectious disease physician) and applied the CDC’s Core Elements of Outpatient Antibiotic Stewardship. The program covered 18 hospital-affiliated ambulatory departments (primary care, specialty clinics, urgent care, and the emergency department) and targeted six “high-priority” respiratory diagnoses identified via ICD-10: upper respiratory infection, acute bronchitis, sinusitis, otitis media, streptococcal pharyngitis, and pneumonia.<br /><br />Using AHRQ ambulatory stewardship toolkit guidelines, the team extracted visit data from the electronic medical record, performed retrospective chart audits, and provided monthly email feedback to providers, with infectious disease review of disputed cases and pharmacist support for prescribing questions. In 2024, 1,970 antibiotic prescriptions tied to these conditions were audited (7,220 total visits), and 15.48% were deemed inappropriate; inappropriate prescribing fell from 19.37% to 15.48% during the year.<br /><br />Key outcomes showed a 48% reduction in antibiotic prescribing rates (528.32 per 1,000 persons in 2023 vs 270.91 in 2024; p<.05). Community-acquired C. difficile admissions decreased from 21 to 16 (24% reduction; not statistically significant overall), while the share of C. difficile admissions preceded by outpatient antibiotics within 90 days dropped significantly (33% to 6%; p<.05). The program estimated net savings by avoiding five admissions (~$50,430 saved) versus program costs of ~$8,322.50. Limitations included focusing only on hospital-affiliated sites, six respiratory conditions, and hospital admissions only.

Keywords

outpatient antimicrobial stewardship

antibiotic prescribing improvement

community-acquired Clostridioides difficile

CDC Core Elements outpatient stewardship

respiratory infection ICD-10 diagnoses

AHRQ ambulatory stewardship toolkit

electronic medical record chart audit

provider feedback and peer comparison

inappropriate antibiotic prescribing reduction

cost savings from avoided C. difficile admissions