Program Schedule

Evaluation of the Diagnosis and Management of Hospital-Onset Healthcare Facility Associated (HO-HCFA) Clostridium difficile Infection at a Veterans Affairs (VA) Hospital

Session: Poster Abstract Session: Clostridium difficile Infection: Epidemiology, Presentation, Treatment
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • CDIposter_IDWeek_2014_2-1.pdf (484.5 kB)
  • Background: Clostridium difficile infection (CDI) is a growing problem.  Deciding which patients will benefit from CDI testing remains a challenge as only 10-20% of nosocomial diarrhea is due to C. difficile.  Testing for CDI without evaluation for common causes of nosocomial diarrhea and testing asymptomatic patients may lead to detection and unnecessary treatment of asymptomatic C. difficile carriage. Our objective was to define the characteristics and appropriateness of CDI testing as well as management of confirmed cases, and  identify opportunities for quality improvement.

    Methods: We conducted a retrospective chart review of patients undergoing testing for HO-HCFA CDI from July 1st, 2012 to July 31st, 2013.  Each CDI testing episode was evaluated for documentation of a clinical syndrome consistent with CDI (> 3 unformed stools in 24 hour period), laxative use within 72 hours prior to testing and receipt of concurrent enteral nutrition.   Each CDI case was classified by severity and treatment assessed for agreement with guidelines. 

    Results: 117 CDI testing episodes occurred in 92 patients, of which 79% (93/117) were negative. 21% of patients lacked documentation of > 3 unformed stools in 24h.  42% (49/117) of patients received at least one dose of laxative prior to CDI testing. Of those who tested negative, 39% (36/93) were receiving laxatives prior to testing, and 33% (31/93) were receiving enteral feeds at the time of testing.   Of those with confirmed CDI, 100% (9/9) with mild-moderate infection were treated appropriately, 0% (0/5) with severe infection, and 0% (0/2) with severe-complicated infection. Asymptomatically-colonized patients were treated 88% (7/8) of the time.

    Conclusion: A significant proportion of CDI tests at our facility are avoidable due to testing of asymptomatic patients and those with alternative explanations for nosocomial diarrhea.  Excessive CDI testing may lead to detection and inappropriate treatment of asymptomatically colonized patients. A significant number of patients are not treated according to recommended guidelines. We identified significant variations from best practices in diagnosis and management of CDI among our Veteran population, which will serve as opportunities for future antimicrobial stewardship intervention.

    Thomas Kerr, PharmD, Patricia Orlando, PharmD and Emily Sydnor, MD, MHS, VA Salt Lake City Health System, Salt Lake City, UT


    T. Kerr, None

    P. Orlando, None

    E. Sydnor, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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