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Cephalosporin stewardship is a challenge because they are workhorses and their standard of care for patients with febrile neutropenia and other conditions, so it does make it difficult but we are doing the best we can to limit unnecessary use, and shortened duration, etc., is really important. Otherwise, in terms of how a stewardship program is run, having a formal program is an essential strategy— not just as a memo or a best practice, but having a formal program where you have a pharmacist or a medical director overseeing it.”
Finally, Perl shared insights on what it takes to actually prevent C. diff.“ It takes a village, a very global response, which includes infection prevention and stewardship,” Perl said.“ The best anecdote I can share is from Quebec in the early 2000s when the new 027 strain emerged and they did gorgeous epidemiologic studies and demonstrated the importance then of the fluoroquinolones alone. But what is fascinating is whenever you talked to the practitioners and asked them what stopped the outbreak, they said it was the aggressive infection control practices. Then you’ d go to the next practitioner who would say it was stopping the fluoroquinolones. So I think the moral of the story is is that you do all of this and it’ s sometimes frustrating if you just do one element, you may not have the success you want. This is an organism that really needs to be attacked in multiple ways from multiple perspectives.”
References:
Keegan LT, Tanner W, and Orleans B, et al. Environmental and Health Care Personnel Sampling and Unobserved Clostridium difficile Transmission in ICU. JAMA Network Open. 2025; 8;( 4): e252787. doi: 10.1001 / jamanetworkopen
Miles-Jay A, Snitkin ES, and Lin MY, et al. Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit. Nat Med 29, 2526 – 2534( 2023). https:// doi. org / 10.1038 / s41591-023- 02549-4
Tang S, Shepard S, and Clark R, et al. Guiding Clostridioides difficile Infection Prevention Efforts in a Hospital Setting With AI. JAMA Netw Open. 2025; 8;( 6): e2515213. doi: 10.1001 / jamanetworkopen. 2025.15213
It takes a village, a very global response, which includes infection prevention and stewardship.”
— Trish Perl, MD
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