Program Schedule

Lack of Adherence to SHEA-IDSA Treatment Guidelines for Severe Clostridium difficile Infection is Associated with Increased Mortality

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:  Clostridium difficile infection (CDI) is associated with 14,000 deaths every year in the US according to the Center for Disease Control (CDC). In 2010, the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (SHEA-IDSA) published guidelines stratifying the severity of CDI in patients based on their clinical presentation and laboratory values. They recommend specific initial treatment of CDI based on this severity stratification.

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.

Ishan Patel, Manida Wungjiranirun, MD, Thimmaiah Theethira, MD, Javier Villafuerte, MD, Daniel Leffler, MD, MS and Ciaran Kelly, MD, Beth Israel Deaconess Medical Center, Boston, MA


I. Patel, None

M. Wungjiranirun, None

T. Theethira, None

J. Villafuerte, None

D. Leffler, None

C. Kelly, None

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