An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings

M.A. Aldeyab, M.P. Kearney, M.G. Scott, M.A. Aldiab, Y.M. Alahmadi, F.W. Darwish Elhajji, F.A. Magee, J.C. McElnay

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116 Citations (Scopus)


Objectives: To evaluate the impact of a high-risk antibiotic stewardship programme on reducing antibiotic use and on hospital Clostridium difficile infection (CDI) incidence rates. A secondary objective was to present the possible utility of time-series analysis as an antibiotic risk classification tool. Methods: This was an interventional, retrospective, ecological investigation in a medium-sized hospital over 6.5 years (January 2004 to June 2010). The intervention was the restriction of high-risk antibiotics (second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and clindamycin). Amoxicillin/clavulanic acid and macrolides were classified as medium-risk antibiotics based on time-series analysis findings and their use was monitored. The intervention was evaluated by segmented regression analysis of interrupted time series. Results: The intervention was associated with a significant change in level of use of high-risk antibiotics (coefficient -17.3, P<0.0001) and with a borderline significant trend change in their use being reduced by 0.156 defined daily doses/100 bed-days per month (P=0.0597). The reduction in the use of high-risk antibiotics was associated with a significant change in the incidence trend of CDI (P=0.0081), i.e. the CDI incidence rate decreased by 0.0047/100 bed-days per month. Analysis showed that variations in the incidence of CDI were affected by the age-adjusted comorbidity index with a lag of 1 month (coefficient 0.137051, P=0.0182). Significant decreases in slope (coefficient -0.414, P=.0309) post-intervention were also observed for the monitored medium-risk antibiotics. Conclusions: The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Original languageEnglish
Pages (from-to)2988-2996
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Issue number12
Early online date16 Aug 2012
Publication statusPublished (in print/issue) - 1 Dec 2012

Bibliographical note

Cited By :74

Export Date: 15 September 2018


Correspondence Address: Aldeyab, M.A.; Clinical and Practice Research Group, School of Pharmacy, Queens University Belfast, BT9 7BL Belfast, Northern Ireland, United Kingdom; email:

Chemicals/CAS: amoxicillin plus clavulanic acid, 74469-00-4, 79198-29-1; clindamycin, 18323-44-9; Anti-Bacterial Agents

Funding details: DSR, KFU, Deanship of Scientific Research, King Faisal University

Funding details: DSR, Department of Sport and Recreation, Government of Western Australia

Funding details: 7-968-D1432, KAU, King Abdulaziz University

Funding text: Work by Motasem A. Aldiab was thankfully funded by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah, under grant no. 7-968-D1432. The study was carried out as part of the routine work of the remaining authors.

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  • C. difficile infection
  • Quality improvement
  • Risk classification
  • Time-series analysis
  • amoxicillin plus clavulanic acid
  • cephalosporin derivative
  • clindamycin
  • macrolide
  • quinolone derivative
  • antiinfective agent
  • antibiotic therapy
  • article
  • Clostridium difficile infection
  • comorbidity
  • drug utilization
  • hospital policy
  • human
  • incidence
  • major clinical study
  • medication therapy management
  • patient compliance
  • retrospective study
  • Clostridium difficile
  • Clostridium infection
  • cross infection
  • diarrhea
  • hospital
  • isolation and purification
  • microbiology
  • standard
  • statistics
  • Anti-Bacterial Agents
  • Clostridium Infections
  • Cross Infection
  • Diarrhea
  • Drug Utilization
  • Hospitals
  • Humans
  • Incidence
  • Retrospective Studies


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