3852 From broad-spectrum to broad thinking: frailty-based antibiotic stewardship in action

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.