Use of data envelopment analysis to quantify opportunities for antibacterial targets for reduction of health care-associated Clostridium difficile infection.

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Abstract

Clostridium difficile infection (CDI) is an important health care-associated infection that leads to increased morbidity and mortality. Antibacterial medications used in hospitals serve as targets for antibacterial stewardship programs to reduce C difficile. The objective was to create a benchmark strategy targeting high-risk antibacterials for C difficile. This was a retrospective cross-sectional study using claims data from 58 hospitals. The Data Envelopment Analysis Technique was used to identify best-practice hospitals in terms of less use of 5 classes of antibacterials and fewer CDIs. Of 58 hospitals, 17 (29%) were identified as best-practice hospitals. Antibacterial classes requiring the greatest percentage reduction in use in non-best-practice hospitals versus best-practice hospitals were clindamycin (31%), β-lactam/β-lactamase combinations (30%), and carbapenems (29%). This study suggests that there are areas of improvement in high-risk antibacterial use that could lead to decreased CDIs.