Background Clostridioides difficile infection (CDI) is highly contagious, characterized by a high recurrence rate, and poses a significant challenge in hospital infection control and healthcare economics. Objective This study aimed to investigate the impact of educational and antimicrobial stewardship interventions targeting healthcare workers on the incidence of CDI, treatment prescription patterns, and healthcare costs. Methods This retrospective, observational study was conducted in a single acute-care hospital. Educational and antimicrobial stewardship interventions aimed at improving CDI control and treatment were implemented among healthcare workers. These interventions included hospital-wide training sessions, revision of the Infection Control Manual, dissemination of information to individual wards, and case-specific interventions. The primary outcome was changes in CDI incidence per 10,000 patient-days, comparing the 19-month periods before and after the intervention. The secondary outcomes included changes in CDI treatment prescription rates and an economic evaluation of drug costs, hospitalization fees, and infection control-related expenses between the two periods. Results A total of 75 developed CDI in the pre-intervention period and 40 developed in the post-intervention period. The CDI incidence decreased from 4.148 to 2.103 per 10,000 patient-days, representing a 49% reduction. Additionally, the prescription rate of metronidazole decreased, whereas that of fidaxomicin increased. Although drug costs increased, the total monthly healthcare expenditures, including hospitalization expenses, decreased by 55%. Discussion Educational and antimicrobial stewardship interventions targeting healthcare workers effectively reduced CDI incidence and improved cost-effectiveness in hospital care.
Nagaoka et al. (2026) studied this question.