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Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis
  1. Paige A Bishop1,
  2. Carmen Isache2,
  3. Yvette S McCarter3,
  4. Carmen Smotherman4,
  5. Shiva Gautam4,
  6. Christopher A Jankowski1
  1. 1 Department of Pharmacy, University of Florida Health at Jacksonville, Jacksonville, Florida, USA
  2. 2 Department of Medicine, UF Health Jacksonville, Jacksonville, Florida, USA
  3. 3 Department of Pathology and Laboratory Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
  4. 4 Center for Data Solutions, University of Florida College of Medicine, Jacksonville, Florida, USA
  1. Correspondence to Dr Christopher A Jankowski, Department of Pharmacy, University of Florida Health at Jacksonville, Jacksonville, FL 32209, USA; christopher.jankowski{at}


Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

  • clostridium difficile
  • clostridium infections

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  • Contributors All authors of this manuscript contributed significantly to the design, execution, analysis, interpretation, and writing of this work. This manuscript has been reviewed and approved for submission by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data

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