Abstract Introduction Since COVID-19, Clostridioides difficile infection (CDI) rates have increased nationally, including at South Warwickshire Hospital Foundation Trust (SWFT) during 2022–2023. A Quality Improvement Project (QIP), in collaboration with the Antimicrobial Stewardship (AMS) team, identified older adults with frailty as high-risk for receiving broad-spectrum antibiotics, which were linked to higher CDI rates and poorer outcomes. To address this, a frailty-specific antimicrobial guideline was introduced to reduce inappropriate broad-spectrum antibiotic use, particularly co-amoxiclav, and improve clinical outcomes. The QIP aimed to evaluate prescribing practices, ensure adherence to trust guidelines, and encourage multidisciplinary collaboration. Method In 2022, 40 patients (20 in-patients, 20 virtual frailty ward patients) were audited. Data from the first cycle showed that 75% of in-patients received antibiotics outside of guidelines, with 50% of these prescribed co-amoxiclav. It was found that acute frailty presentations (e.g. delirium, falls, ‘off legs’) were often misdiagnosed, leading to unnecessary broad-spectrum antibiotic use. In response, the new guideline introduced an ‘Acute Frailty Syndrome’ category, promoting 2 to 3 narrow spectrum alternatives when the infection source was unclear. The guideline was implemented across inpatient and community settings, with targeted education delivered to high-impact areas such as Emergency Medicine and the Frailty Assessment Area. Results A second audit cycle in 2025 showed significant improvements: only 20% of in-patients were prescribed antibiotics outside guidelines, and inappropriate co-amoxiclav use dropped by 45%. Re-admission rates within 30 days also fell from 15% to 5%. Conclusion In conclusion, introducing a frailty-specific antibiotic guideline and strengthening multidisciplinary practices led to safer prescribing, reduced CDI risk, and better outcomes for older adults living with frailty at SWFT.
Jaspal et al. (Sun,) studied this question.