{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:38:58Z","timestamp":1792075138653,"version":"4.4.0"},"reference-count":26,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chung-Ang University Research Grants"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background\/Objectives: Growing concerns about antibiotic-associated adverse events, including Clostridioides difficile infection, prompted implementation of an antibiotic stewardship program (ASP) in South Korea in November 2024. One year post-implementation, we evaluated changes in antibiotic consumption and C. difficile infection incidence. Methods: This study was conducted at Chung-Ang University Gwangmyeong Hospital, South Korea. Segmented regression and interrupted time series analyses were performed using weekly data on antibiotic use (days of therapy [DOT] per 1000 patient-days) and C. difficile infection or colonization (cases per 1000 patient-days) over 157 weeks (November 2022\u2013October 2025). Weeks 1\u2013105 defined the pre-ASP period, and weeks 106\u2013157 the post-ASP period. A 4-week lag between antibiotic use and subsequent C. difficile infection was hypothesized. Results: Before ASP, weekly total antibiotic use increased (\u03b21 = 1.14, 95% CI, 0.76 to 1.51, p &lt; 0.001). After ASP, the slope decreased significantly (\u03b23 = \u22121.50, 95% CI \u22122.62 to \u22120.39, p = 0.009), consistent across anti-pseudomonal penicillins and cephalosporins and fluoroquinolones. Pre-ASP C. difficile incidence increased (\u03b11 = 0.01, 95% CI, 0.01 to 0.02, p &lt; 0.001); the upward trend attenuated post-ASP, though slope change was not significant (\u03b13 = \u22120.01, 95% CI, \u22120.03 to 0.004, p = 0.13). An increase of 1 DOT per 1000 patient-days was associated with a 0.005-case increase in C. difficile infection incidence after 4 weeks. Conclusions: The observed effects of proactive ASP strategies underscore the importance of maintaining stewardship in clinical practice. Further studies are warranted to assess the sustainability of these findings and evaluate additional factors influencing C. difficile infection incidence.<\/jats:p>","DOI":"10.3390\/antibiotics15020112","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:16:59Z","timestamp":1769159819000},"page":"112","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effects of Antibiotic Stewardship Program on Antibiotic Consumption and the Incidence of Clostridioides difficile Infection"],"prefix":"10.3390","volume":"15","author":[{"given":"Joung Ha","family":"Park","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juhee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyemin","family":"Chung","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min-Chul","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, 110 Deokan-ro, Gwangmyeong-si 14353, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Borren, N.Z., Ghadermarzi, S., Hutfless, S., and Ananthakrishnan, A.N. (2017). The emergence of Clostridium difficile infection in Asia: A systematic review and meta-analysis of incidence and impact. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176797"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e118","DOI":"10.3346\/jkms.2024.39.e118","article-title":"Incidence of Clostridioides difficile Infections in Republic of Korea: A Prospective Study With Active Surveillance vs. National Data From Health Insurance Review & Assessment Service","volume":"39","author":"Kim","year":"2024","journal-title":"J. Korean Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1917597","DOI":"10.1001\/jamanetworkopen.2019.17597","article-title":"Incidence and Outcomes Associated with Clostridium difficile Infections: A Systematic Review and Meta-analysis","volume":"3","author":"Marra","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.tim.2012.04.001","article-title":"Interaction between the intestinal microbiota and host in Clostridium difficile colonization resistance","volume":"20","author":"Britton","year":"2012","journal-title":"Trends Microbiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1097\/01.qco.0000433318.82618.c6","article-title":"Recent insights into Clostridium difficile pathogenesis","volume":"26","author":"Peniche","year":"2013","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_6","unstructured":"Centers for Disease Control and Prevention (2019). Core Elements of Hospital Antibiotic Stewardship Programs, US Department of Health Human Services, C.D.C."},{"key":"ref_7","first-page":"CD003543","article-title":"Interventions to improve antibiotic prescribing practices for hospital inpatients","volume":"2","author":"Davey","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3947\/ic.2021.0098","article-title":"Guidelines on Implementing Antimicrobial Stewardship Programs in Korea","volume":"53","author":"Yoon","year":"2021","journal-title":"Infect. Chemother."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e2253806","DOI":"10.1001\/jamanetworkopen.2022.53806","article-title":"Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis","volume":"6","author":"Win","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5040","DOI":"10.1038\/s41598-023-32329-6","article-title":"Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics","volume":"13","author":"Aiesh","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ajic.2009.04.288","article-title":"Effectiveness of drug use evaluation and antibiotic authorization on patients\u2019 clinical outcomes, antibiotic consumption, and antibiotic expenditures","volume":"38","author":"Rattanaumpawan","year":"2010","journal-title":"Am. J. Infect. Control."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1860.e1","DOI":"10.1016\/j.cmi.2021.07.019","article-title":"Effect of discontinuation of an antimicrobial stewardship programme on the antibiotic usage pattern","volume":"27","author":"Jang","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1001\/jama.280.14.1233","article-title":"Class restriction of cephalosporin use to control total cephalosporin resistance in nosocomial Klebsiella","volume":"280","author":"Rahal","year":"1998","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Liu, P., Ohl, C., Johnson, J., Williamson, J., Beardsley, J., and Luther, V. (2016). Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infect. Dis., 16.","DOI":"10.1186\/s12879-016-2080-3"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2082","DOI":"10.1128\/AAC.01214-08","article-title":"Quasiexperimental study of the effects of antibiotic use, gastric acid-suppressive agents, and infection control practices on the incidence of Clostridium difficile-associated diarrhea in hospitalized patients","volume":"53","author":"Aldeyab","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e407","DOI":"10.3346\/jkms.2020.35.e407","article-title":"Association between Antibiotic Consumption and Incidence of Clostridioides difficile Infection in a Hospital","volume":"35","author":"Kim","year":"2020","journal-title":"J. Korean Med. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/S1473-3099(17)30325-0","article-title":"Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: A systematic review and meta-analysis","volume":"17","author":"Baur","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1093\/jac\/dku046","article-title":"Effect of antibiotic stewardship programmes on Clostridium difficile incidence: A systematic review and meta-analysis","volume":"69","author":"Feazel","year":"2014","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/cid\/ciz169","article-title":"Association Between Antibiotic Use and Hospital-onset Clostridioides difficile Infection in US Acute Care Hospitals, 2006\u20132012: An Ecologic Analysis","volume":"70","author":"Kazakova","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s15010-014-0693-2","article-title":"Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany","volume":"43","author":"Borde","year":"2015","journal-title":"Infection"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1086\/664765","article-title":"Antibiotic stewardship for intra-abdominal infections: Early impact on antimicrobial use and patient outcomes","volume":"33","author":"Dubrovskaya","year":"2012","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMra1403772","article-title":"Clostridium difficile infection","volume":"372","author":"Leffler","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3201\/eid1305.061124","article-title":"Antimicrobial drugs and community-acquired Clostridium difficile-associated disease, UK","volume":"13","author":"Delaney","year":"2007","journal-title":"Emerg. Infect. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2988","DOI":"10.1093\/jac\/dks330","article-title":"An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings","volume":"67","author":"Aldeyab","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_25","first-page":"348","article-title":"Interrupted time series regression for the evaluation of public health interventions: A tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int. J. Epidemiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1046\/j.1365-2710.2002.00430.x","article-title":"Segmented regression analysis of interrupted time series studies in medication use research","volume":"27","author":"Wagner","year":"2002","journal-title":"J. Clin. Pharm. Ther."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/2\/112\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:45:22Z","timestamp":1769161522000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/2\/112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,23]]},"references-count":26,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["antibiotics15020112"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15020112","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,23]]}}}