78. A Healthcare Provider Educational Intervention to Reduce Unnecessary Clostridium difficile PCR Testing in Pediatric Patients: A Segmented Regression Analysis
Session: Oral Abstract Session: Pediatric Bacterial Infections and Colonization
Thursday, October 8, 2015: 9:45 AM
Room: 32--ABC

Background: C. difficile infections (CDIs) are increasingly diagnosed in children and are predominantly community-associated (CA). Many children with CDI lack classic risk factors. Frequent use of highly sensitive tcdB PCR testing in low-risk patients may lead to CDI misdiagnosis and unnecessary CDI antibiotic use in asymptomatic carriers.

Methods: An educational intervention (EI) was undertaken 9/2013-1/2014 to improve healthcare provider (HCP) understanding of limitations of tcdB PCR tests. An electronic HCP notification was built into the tcdB PCR test order that describes scenarios in which carriage is more likely than CDI. Didactic education was provided to several groups of HCPs. Segmented regression analysis of interrupted time series data was performed to assess changes in level (i.e., overall rates) and trend of CDI testing rate (TR; tests performed / 1000 patient encounters) and test positivity rate (PR; positive tests / 1000 patient encounters) between pre- (8/2009-8/2013) and post-EI (2/2014-2/2015) periods. We performed identical subset analyses for inpatient (IP), outpatient (OP), and emergency department (ED) settings. We also compared rates of publicly reported hospital-onset (HO) and community-onset (CO) healthcare facility-associated (HCFA) CDI rates (CDIs / 10,000 inpatient days).

Results: The table lists changes in pre- and post-EI CDI TR and PR. Figures 1 and 2 illustrate trends in OP CDI TR and PR, respectively.

Conclusion: Significant decreases in CDI TR and PR were observed after a HCP EI, particularly among OPs. These findings suggest that HCP education reduces CDI misdiagnoses by improving CDI test utilization in low-risk children. We estimate that the HCP EI reduced annual patient charges for tcdB PCR tests by $122,544 and prevented up to 63 unnecessary courses of antibiotics for CDI per year.

Table: Educational Intervention Effect on CDI Testing

 

Pre-EI

Post-EI

p value: Level

p value: Trend

Total TR

2.25

1.62

0.015

0.10

Total PR

0.40

0.28

0.73

<0.001

IP TR

56.63

40.39

0.38

0.64

IP PR

8.62

6.67

0.41

0.01

OP TR

0.81

0.57

<0.0001

<0.01

OP PR

0.17

0.09

<0.01

0.086

ED TR

2.1

1.45

0.018

0.56

ED PR

0.45

0.35

0.76

<0.01

HO-HCFA CDI Rate

3.55

4.52

0.63

0.95

CO-HCFA CDI Rate

5.24

4.67

0.83

0.03

Bolded p values indicate statistical significance

Larry Kociolek, MD1,2, Maria Bovee, MPH, CIC3, Donna Carter, BS, MT(ASCP)4, Anna O'donnell, MSN, RN, CIC3, Angela Rupp, MT, MS, CIC3, Jody Ciolino, PhD5, Xiaotian Zheng, MD PhD4,6, Stanford Shulman, MD, FIDSA, FPIDS1,2 and Sameer Patel, MD, MPH1,2, (1)Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (2)Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, (3)Infection Prevention and Control, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (4)Microbiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (5)Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, (6)Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL

Disclosures:

L. Kociolek, Merck: Grant Investigator , Grant recipient
Cubist: Grant Investigator , Grant recipient
Alere: Investigator , Research support

M. Bovee, None

D. Carter, None

A. O'donnell, None

A. Rupp, None

J. Ciolino, None

X. Zheng, None

S. Shulman, None

S. Patel, Cubist: Grant Investigator , Grant recipient

<< Previous Abstract | Next Abstract

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.