OBJECTIVE: The objective of this study was to test the hypothesis that many patients with suspected Clostridium difficile infection (CDI) receive inappropriate empiric therapy and/or receive continued therapy despite negative test results. METHODS: We performed a 3 month prospective cohort study at the Cleveland Veteran Affairs Medical Center to assess the appropriateness of empiric CDI therapy for all patients with stool samples submitted for CDI testing. Empiric therapy for CDI was considered appropriate if patients with suspected CDI had findings suggestive of severe or complicated illness. RESULTS: Of 251 patients tested for CDI, 53 (21%) received empiric treatment, including 45 (85%) treated with metronidazole and 8 (15%) treated with vancomycin. Of the 53 empirical therapy regimens, only 20 (38%) were deemed appropriate based on criteria for severe or severe, complicated CDI and 39 (74%) had negative laboratory testing for CDI. Twenty-one of 39 (54%) patients with negative testing were continued on therapy for three or more days despite the negative results. The key limitations of the study are the fact that it was conducted in a single institution and had a small sample size. CONCLUSION: In our facility, empiric treatment for CDI was common and more than half of empirical treatment was deemed inappropriate because patients did not meet criteria for severe CDI. Because CDI therapy may be associated with adverse effects, there is a need for interventions to improve the appropriateness of empiric CDI treatment.
OBJECTIVE: The objective of this study was to test the hypothesis that many patients with suspected Clostridium difficileinfection (CDI) receive inappropriate empiric therapy and/or receive continued therapy despite negative test results. METHODS: We performed a 3 month prospective cohort study at the Cleveland Veteran Affairs Medical Center to assess the appropriateness of empiric CDI therapy for all patients with stool samples submitted for CDI testing. Empiric therapy for CDI was considered appropriate if patients with suspected CDI had findings suggestive of severe or complicated illness. RESULTS: Of 251 patients tested for CDI, 53 (21%) received empiric treatment, including 45 (85%) treated with metronidazole and 8 (15%) treated with vancomycin. Of the 53 empirical therapy regimens, only 20 (38%) were deemed appropriate based on criteria for severe or severe, complicated CDI and 39 (74%) had negative laboratory testing for CDI. Twenty-one of 39 (54%) patients with negative testing were continued on therapy for three or more days despite the negative results. The key limitations of the study are the fact that it was conducted in a single institution and had a small sample size. CONCLUSION: In our facility, empiric treatment for CDI was common and more than half of empirical treatment was deemed inappropriate because patients did not meet criteria for severe CDI. Because CDI therapy may be associated with adverse effects, there is a need for interventions to improve the appropriateness of empiric CDI treatment.
Authors: Brittany B Lewis; Charlie G Buffie; Rebecca A Carter; Ingrid Leiner; Nora C Toussaint; Liza C Miller; Asia Gobourne; Lilan Ling; Eric G Pamer Journal: J Infect Dis Date: 2015-04-28 Impact factor: 5.226
Authors: Hee Bum Jo; Sin Young Ham; Jongtak Jung; Song Mi Moon; Nak-Hyun Kim; Kyoung-Ho Song; Jeong Su Park; Kyoung Un Park; Eu Suk Kim; Hong Bin Kim Journal: Antimicrob Resist Infect Control Date: 2022-05-13 Impact factor: 4.887
Authors: Simon D Goldenberg; Karen N Bisnauthsing; Amita Patel; Anne Postulka; Duncan Wyncoll; Rebekah Schiff; Gary L French Journal: Infect Dis Ther Date: 2014-09-10