Lack of Adherence to SHEA-IDSA Treatment Guidelines for Severe Clostridium difficile Infection is Associated with Increased Mortality
Aim: 1) To determine our institution’s compliance with the Clostridium difficile treatment guidelines. 2) To determine whether noncompliance with the Clostridium difficile treatment guidelines was associated with adverse outcomes.
Methods: Patients presenting to our institution from December 2012 to November 2013 with a diagnosis of CDI were identified. Clinical parameters, Laboratory values and Clinical course were obtained from electronic medical records. An adverse outcome of 90 day mortality with CDI as a primary or contributing factor was used.
Results: 230 patients met our inclusion criteria with a mean age of 63 ± 17. 143 (62%) patients from our study population were male. Adherence to the treatment guidelines recommended by SHEA-IDSA revealed that 124 (54%) were appropriately treated, 45 (19.5%) were under-treated and 61 (26.5%) were over-treated. Adherence to SHEA-IDSA treatment guidelines in different CDI groups was as follows: mild-moderate (61%), severe (57%), severe-complicated (33%), 1st recurrence (33%) and 2ndrecurrence (100%). 90 day CDI related mortality occurred in 22 patients. 10 of 45 under-treated patients (22%), 10 of 124 appropriately treated patients (8%) and two of 61 over-treated patients (3%) had 90 day CDI related mortality.
Conclusion: 46% patients did not receive treatment in accordance to SHEA-IDSA guidelines. More than half of these were over-treated while under-treatment occurred in 19.5% of cases. Under-treatment was associated with a high mortality (22% versus 8% in those appropriately treated; p=0.027). These data suggest that adherence to CDI guidelines is associated with improved outcomes and emphasis on provision of appropriate guideline-based treatment appears warranted.
T. Theethira, None
J. Villafuerte, None
D. Leffler, None
C. Kelly, None
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