1055. Effect of the IDSA/SHEA Guidelines on Physician Prescribing Practices for Severe Clostridium difficile Infection (CDI) at an Academic Tertiary Care Hospital
Session: Poster Abstract Session: Guidelines in Clinical Practice
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA VENUGOPAL CDI GL 2011.pdf (114.9 kB)
  • Background: In May 2010 the IDSA/SHEA developed clinical practice guidelines for the management of CDI in adults (Cohen SH, ICHE, 2010). We evaluated the effect of these guidelines on treatment of severe CDI at an academic tertiary care hospital. 

    Methods: All adult patients with CDI from 10/15/09-12/31/10 were included.  The following data were collected:  severity of illness (mild/moderate or severe), initial antibiotic choice, outcome (alive or dead at 30 days after CDI episode) and whether an Infectious Diseases (ID) consultation was placed. Severity of illness and treatment recommendations were defined using the guidelines.  Data were compared in the pre-guideline (10/15/09-5/31/10) and post-guideline (6/1-12/31/10) periods using X2 and Student’s t test.  Statistical analysis was performed using SPSS v. 19.0 and a p<0.05 was considered significant.

    Results: Among 221 CDI patients identified during the study period, 206 received treatment with either metronidazole (MZ) or vancomycin (VA) including 127 pre- and 79 post-guidelines respectively.  Most patients (55.7%) had severe disease; there was no difference in disease severity between pre- and post-guidelines periods (X2, p=0.87).  ID consults were obtained more frequently in patients with severe CDI compared with mild/moderate CDI (77% vs. 55%, p=0.001). There was no increase in overall VA use in the two time periods (15.7% vs. 12.7%, p=0.54). ID consultants were more likely to use VA for severe CDI than other physicians in both time periods (21% vs. 1.5%, p<0.0001).  There was no effect of the guidelines on ID use of VA for severe CDI (22.6% pre- and 18.2% post-guidelines, p=0.79).  Despite the low frequency of compliance with guidelines, there was no difference noted in 30-day mortality in patients with severe vs. mild/moderate disease (28.7% vs. 19.6%, p=0.12).

    Conclusion: There was no increase in VA use for severe CDI in the six month period following the release of the IDSA/SHEA clinical practice guideline. ID physicians were more likely to be consulted for severe CDI and prescribe VA appropriately for severe CDI in both periods but there was no effect of the guidelines on the treatment of severe CDI. Long term studies should be performed to determine late effects of the guidelines on treatment. 


    Subject Category: J. Clinical practice issues

    Kathryn Sanchez, MD1, Susan Szpunar, PhD1, Leonard Johnson, MD1,2 and Anilrudh Venugopal, MD1,2, (1)St. John Hospital and Medical Center, Grosse Pointe Woods, MI, (2)School of Medicine, Wayne State University, Grosse Pointe Woods, MI

    Disclosures:

    K. Sanchez, None

    S. Szpunar, None

    L. Johnson, None

    A. Venugopal, None

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