190Adequacy of Prior Antibiotic Use in Patients with Clostridium difficile Infection: A Resptrospective Analysis

Background. Clostridium difficile infections (CDI) are the main cause of healthcare associated diarrhea. Inappropriate use of antibiotics (AB) is a significant risk factor for CDI. The aim of this study is to determine the proportion of CDI patients who received inappropriate AB prior to developing CDI. Methods. This is a retrospective cohort study to assess the proportion of newly diagnosed CDI patients whose AB regimen could have been optimized prior to CDI episode at a tertiary medical center. The study population, identified through a Microbiology lab database, included patients with a first episode of CDI between February and May 2013. Each patient’s AB regimen, indications and culture results were reviewed using a standardized form. AB therapy was defined as inappropriate when ≥1 of the following were met: (1) absence of a clear and valid indication to initiate therapy; (2) deviation of initial empiric therapy from local recommendations; (3) inappropriate de-escalation or duration of therapy. Inappropriateness of AB was determined by a panel of experts in CDI and antibiotic stewardship. Ethics approval was obtained before starting the chart review. Results. 50 patients with CDI were identified (52% male, mean age, 76yrs). 47% had received AB in the previous 5 weeks and 53% received therapy on the day of CDI diagnosis. ABs prescribed were 54% penicillin, 44% quinolones, 20% cephaloporines and 18% carbapenems for the following conditions: penumonia 24%, urinary tract infection 11%, skin and soft tissue infection 12%, 32% for other indications. 10% received antibiotics for prophylaxis. 49% (n = 24) of patients with CDI had received an inappropriate AB in the previous 5 weeks. The main sources of inappropriate use were: failure to de-escalate (n = 9; 38%); inappropriate duration (n = 13; 54%); absence of clear diagnosis on day 3 of therapy (n = 4; 20%); and failure to switch to a narrower spectrum AB despite diagnostic test results and clinical improvement (n = 9; 38%). Conclusion. A significant proportion of CDI cases received an inappropriate course of AB in the previous 5 weeks illustrating the need to improve AB use in our hospital. Antimicrobial stewardship has been initiated and a prospective audit is being planned to investigate its effect on CDI rates. Disclosures. All authors: No reported disclosures.