Abstract：
Clostridium difficile causes nearly 500 000 annual infections in the USA. A total of 15 000-30 000 US deaths annually and greater than US$4.8 billion dollars are related to Clostridium difficile infection (CDI). Length of hospital stay is 2.8 -5.5 additional days and inpatient costs are estimated at US$3000-US$15 400 per episode. One major cause of CDI is misuse and overuse of antibiotics. The Centers for Disease Control and Prevention reports that 30%-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. Patients with unexplained or three or greater unformed stools in 24 hours are candidates for testing of CDI.Prior to implementation, an analysis at the local level was conducted to determine possible causes of CDI influence. Chart auditing at this urban hospital revealed that 1 out of 23 (4%) providers were treating UTIs according to hospital protocol (A. Richmond, personal communication, 6 March 2018). The standardized infection ratio in 2017, which compares the predicted to the actual infection rate, at this hospital was 1.266 for CDI. Having a solid antibiotic stewardship in place is imperative to limit antibiotic related and resistant infections. During an observational study, only one out of nine (11%) staff followed contact precaution policies at this hospital.
摘要：
艰难梭菌在美国每年引起近50万例感染。每年共有15000-30000美国死亡和超过48亿美元与艰难梭菌感染（CDI）有关。住院时间为2.8-5.5天，住院费用估计为每集3000-15400美元。CDI的一个主要原因是滥用和过度使用抗生素。疾病控制和预防中心报告说，医院规定的抗生素有30％-50％是不必要或不合适的。24小时内出现不明原因或三次或更多次未形成粪便的患者是CDI测试的候选人。在实施之前，我们在地方层面进行了分析,以确定CDI影响的可能原因.这家城市医院的图表审计显示，23家(4%)的提供者中有1家正在根据医院协议治疗UTI(A.里士满,个人沟通,2018年3月6日）。2017年的标准化感染率，将预测的感染率与实际感染率进行比较，在这家医院，CDI为1.266。有一个坚实的抗生素管理到位是必须限制抗生素相关和耐药性感染。在一项观察性研究中,在这家医院，只有九分之一(11%)的工作人员遵循接触预防政策。
