Evaluation of the Diagnosis and Management of Hospital-Onset Healthcare Facility Associated (HO-HCFA) Clostridium difficile Infection at a Veterans Affairs (VA) Hospital
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.
E. Sydnor, None
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