Universität zu Köln

Classen, Annika Y. ORCID: 0000-0003-2905-5139, Dietz, Thilo ORCID: 0000-0002-9378-6799, Graeff, Luisa Durán, Eisenbeis, Simone, Gastmeier, Petra, Göpel, Siri, Hoffmann, Armin, Hölzl, Florian, Käding, Nadja, Kern, Winfried V., Kramme, Evelyn, Belmar Campos, Cristina, Maurer, Florian P., Seifert, Harald ORCID: 0000-0002-7732-4762, Meißner, Arne, Rohde, Anna M., Rohde, Holger, Rupp, Jan, Tacconelli, Evelina, Walker, Sarah V. ORCID: 0000-0001-8288-1793, Zweigner, Janine ORCID: 0000-0002-0360-434X and Vehreschild, Jörg J. ORCID: 0000-0002-5446-7170 (2025). Impact of enhanced infection control and antimicrobial stewardship on infections by Clostridioides difficile, vancomycin-resistant enterococci, and third-generation cephalosporin-resistant Enterobacterales: a stepped-wedge cluster intervention study. Clinical Microbiology and Infection, 31 (12). pp. 2025-2032. Elsevier. ISSN 1198-743X

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Abstract

Objectives: Infection prevention and control (IPC) and antimicrobial stewardship (AMS) measures are critical to reducing transmission and infection by Clostridioides difficile (CDI) and other enteric patho- gens. This study evaluated the impact of enhanced IPC and AMS on CDI and bloodstream infections (BSIs) caused by vancomycin-resistant enterococci (VRE) and third-generation cephalosporin-resistant Enterobacterales (3GCREB). Methods: The study was conducted in five German university hospitals from January 2016 to July 2019. IPC and AMS interventions were sequentially enhanced in three departments with high-incidence CDI at baseline using a stepped-wedge cluster intervention approach. Main outcome measures were incidence densities of CDI and BSI caused by VRE and 3GCREB. An interrupted time series analysis was performed to assess the intervention effects during a normalized study period. Results: Across 15 departments, >384,000 patient days were included. Incidence density of target infections was low (CDI, 0.77; VRE BSI, 0.07; and 3GCREB BSI, 0.09 per 1000 patient days). Pooled interrupted time series analysis results showed a significant reduction in CDI incidence density fol- lowing the enhancement of AMS measures (AMS period regression slopes difference, 0.089; F[p] = 5.400 [0.037]). Regarding the incidence density of VRE/3GCREB BSI, no relevant changes could be observed (regression slopes difference, 0.19; F[p] = 0.667 [0.429]). A subgroup analysis focusing on haematological and oncological departments showed that AMS influenced prescription behaviour according to implemented AMS strategies, but not clinical outcomes. Discussion: Combined with IPC enhanced short-term AMS measures led to a significant reduction in the incidence of CDI, whereas the incidence of BSI by VRE and 3GCREB remained unchanged in sites with well-established baseline IPC and AMS programmes and low incidence of hospital-associated infections.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Classen, Annika Y. UNSPECIFIED https://orcid.org/0000-0003-2905-5139 UNSPECIFIED Dietz, Thilo UNSPECIFIED https://orcid.org/0000-0002-9378-6799 UNSPECIFIED Graeff, Luisa Durán UNSPECIFIED UNSPECIFIED UNSPECIFIED Eisenbeis, Simone UNSPECIFIED UNSPECIFIED UNSPECIFIED Gastmeier, Petra UNSPECIFIED UNSPECIFIED UNSPECIFIED Göpel, Siri UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Armin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hölzl, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Käding, Nadja UNSPECIFIED UNSPECIFIED UNSPECIFIED Kern, Winfried V. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kramme, Evelyn UNSPECIFIED UNSPECIFIED UNSPECIFIED Belmar Campos, Cristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Maurer, Florian P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Seifert, Harald UNSPECIFIED https://orcid.org/0000-0002-7732-4762 UNSPECIFIED Meißner, Arne UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Anna M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Rupp, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Tacconelli, Evelina UNSPECIFIED UNSPECIFIED UNSPECIFIED Walker, Sarah V. UNSPECIFIED https://orcid.org/0000-0001-8288-1793 UNSPECIFIED Zweigner, Janine UNSPECIFIED https://orcid.org/0000-0002-0360-434X UNSPECIFIED Vehreschild, Jörg J. UNSPECIFIED https://orcid.org/0000-0002-5446-7170 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-809211
Identification Number:	10.1016/j.cmi.2025.08.013
Journal or Publication Title:	Clinical Microbiology and Infection
Volume:	31
Number:	12
Page Range:	pp. 2025-2032
Number of Pages:	8
Date:	December 2025
Publisher:	Elsevier
ISSN:	1198-743X
Language:	English
Faculty:	Faculty of Medicine
Divisions:	CECAD - Cluster of Excellence Cellular Stress Responses in Aging-Associated Diseases Faculty of Medicine > Innere Medizin > Klinik I für Innere Medizin - Hämatologie und Onkologie Faculty of Medicine > Medizinische Mikrobiologie, Immunologie und Hygiene Faculty of Medicine > Medizinische Mikrobiologie, Immunologie und Hygiene > Institut für Medizinische Mikrobiologie, Immunologie und Hygiene Faculty of Medicine > Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft > Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR)
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Antimicrobial stewardship ; Clostridioides difficile ; Haematology-oncology ; Infection prevention and control English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80921