423. Compliance with Institutional Guidelines Improves Outcomes of C.difficile Infection (CDI)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The frequency and severity of CDI has increased in recent years. The objective of this study was to determine predictors of poor outcomes of CDI.
Methods: Retrospective cohort of 200 consecutive cases of CDI at a 903-bed tertiary care center in 2008. CDI cases: presence of diarrhea and a positive stool enzyme immunoassay for C. difficile toxin A or B.
Data collected: Comorbid conditions, severity of infection, treatment, compliance with local guidelines (modified from Owens RC et al, Drugs 2007;67(4):487-502). Treatment outcome, determined by blinded investigators, was characterized as treatment failure or success (clinical resolution of CDI by day 14 or end of treatment without the presence of complications).
Results: Clinical outcomes included 130 (65%) pts with treatment success, 51 (25%) failure, and 19 (10%) indeterminate. Characteristics are listed in Table 1. Independent predictors of treatment failure were non-compliance with guidelines for initial therapy and severe CDI.
Conclusion: Compliance with institutional guidelines was associated with improved CDI outcomes. Failures associated with delayed guideline-driven therapy may reflect a need for improved recognition of severe disease and prompt initiation of CDI therapy.
Table 1. Univariate comparison of clinical characteristics, data presented as n (% within variable)
VariableSuccess
n= 130
Failure
n= 51
P-Value
Age: median (IQR)63 (49-73)67 (52-77)0.213
Gender: Male (n=100)77 (77%)23 (23%)0.085
Charlson Score: median (IQR)3 (1-4)2 (1-3)0.112
ICU (n=50)
GPU (n=131)
28 (56%)
102 (78%)
22 (44%)
29 (22%)
0.003
Severe CDI (n=104)
Non-severe CDI (n=77)
63 (61%)
67 (87%)
41 (39%)
10 (13%)
<0.001
Initial therapy:
Guideline compliant (n=71)
Non compliant (n=110)
61 (86%)
69 (63%)
10 (14%)
41 (37%)
0.001
Time to guideline-driven therapy (median)36 hours49 hours0.03
Rachel Chambers, PharmD1, Susan L Davis, PharmD2, Laura Johnson, MD, Chad Richardson, PharmD1, Marcus Zervos, MD4 and  C. Richardson, None. 
S. L. Davis,
Pfizer Role(s): Grant Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Support, Speaker Honorarium.
R. M. Chambers, None..
L. Johnson, None..
M. Zervos, None., (1)Henry Ford Hospital, Detroit, MI, (2)Wayne State University College of Pharmacy, Detroit, MI, (3)Infectious Disease, Henry Ford Hospital, Detroit, MI