Adam T Brown1, Charles F Seifert2. 1. Texas Tech University Health Sciences Center School of Pharmacy, Lubbock. 2. Texas Tech University Health Sciences Center School of Pharmacy, Lubbock. Electronic address: charles.seifert@ttuhsc.edu.
Abstract
PURPOSE: New guidelines for the treatment of Clostridium difficile-associated diarrhea were published by the Infectious Disease Society of America (IDSA) in 2010, however, there has been no literature evaluating the effectiveness of these guidelines. The purpose of this study was to examine the clinical outcomes of Clostridium difficile infection including death, C difficile infection recurrence, toxic megacolon, and surgery between patients who received guideline-concordant therapy vs guideline-discordant therapy. METHODS: Retrospective case-control study of hospitalized adults with C difficile infection presenting to a 420-bed tertiary care referral county teaching hospital. Patients were identified by International Classification of Diseases-9th Revision codes, and included if they were ≥18 years of age and treated for C difficile infection during their hospital visit. Complication rates (death, infection recurrence, toxic megacolon, and surgery) of patients with C difficile infection were measured to determine if following the IDSA guidelines improves outcomes. RESULTS: Only 51.7% of the patients' prescribers followed the 2010 IDSA guidelines. Patients whose prescribers followed the IDSA guidelines experienced fewer complications than patients whose prescribers strayed from the guidelines (17.2% vs 56.3%, P <.0001). This difference was mainly due to a reduction in mortality (5.4% vs 21.8%, P = .0012) and infection recurrence (14% vs 35.6%, P = .0007). Patients who presented with severe and complicated disease received guideline-based therapy significantly less often than patients with mild disease (19.7%, 35.3%, and 81.2%, respectively, P <.0001). CONCLUSIONS: There was a significant reduction in C difficile infection recurrence and mortality when prescribers followed the IDSA/Society for Healthcare Epidemiology of America guidelines for treatment of C difficile infection.
PURPOSE: New guidelines for the treatment of Clostridium difficile-associated diarrhea were published by the Infectious Disease Society of America (IDSA) in 2010, however, there has been no literature evaluating the effectiveness of these guidelines. The purpose of this study was to examine the clinical outcomes of Clostridium difficile infection including death, C difficile infection recurrence, toxic megacolon, and surgery between patients who received guideline-concordant therapy vs guideline-discordant therapy. METHODS: Retrospective case-control study of hospitalized adults with C difficile infection presenting to a 420-bed tertiary care referral county teaching hospital. Patients were identified by International Classification of Diseases-9th Revision codes, and included if they were ≥18 years of age and treated for C difficile infection during their hospital visit. Complication rates (death, infection recurrence, toxic megacolon, and surgery) of patients with C difficile infection were measured to determine if following the IDSA guidelines improves outcomes. RESULTS: Only 51.7% of the patients' prescribers followed the 2010 IDSA guidelines. Patients whose prescribers followed the IDSA guidelines experienced fewer complications than patients whose prescribers strayed from the guidelines (17.2% vs 56.3%, P <.0001). This difference was mainly due to a reduction in mortality (5.4% vs 21.8%, P = .0012) and infection recurrence (14% vs 35.6%, P = .0007). Patients who presented with severe and complicated disease received guideline-based therapy significantly less often than patients with mild disease (19.7%, 35.3%, and 81.2%, respectively, P <.0001). CONCLUSIONS: There was a significant reduction in C difficile infection recurrence and mortality when prescribers followed the IDSA/Society for Healthcare Epidemiology of America guidelines for treatment of C difficile infection.
Authors: Shannon A Novosad; Yi Mu; Lisa G Winston; Helen Johnston; Elizabeth Basiliere; Danyel M Olson; Monica M Farley; Andrew Revis; Lucy Wilson; Rebecca Perlmutter; Stacy M Holzbauer; Tory Whitten; Erin C Phipps; Ghinwa K Dumyati; Zintars G Beldavs; Valerie L S Ocampo; Corinne M Davis; Marion Kainer; Dale N Gerding; Alice Y Guh Journal: J Gen Intern Med Date: 2019-11-25 Impact factor: 5.128
Authors: I Patel; M Wungjiranirun; T Theethira; J Villafuerte-Galvez; N Castillo; M Akbari; C D Alonso; D A Leffler; C P Kelly Journal: J Antimicrob Chemother Date: 2016-11-14 Impact factor: 5.790
Authors: K T Crowell; K G Julian; M Katzman; A S Berg; A Tinsley; E D Williams; W A Koltun; E Messaris Journal: Epidemiol Infect Date: 2017-06-05 Impact factor: 4.434
Authors: Diane J Schmidt; Gillian Beamer; Jacqueline M Tremblay; Jennifer A Steele; Hyeun Bum Kim; Yaunkai Wang; Michele Debatis; Xingmin Sun; Elena A Kashentseva; Igor P Dmitriev; David T Curiel; Charles B Shoemaker; Saul Tzipori Journal: Clin Vaccine Immunol Date: 2016-09-06