956. Laxative Use and Clostridium difficle Testing and Treatment
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Background: Timely testing and treatment of patients for Clostridium difficile infection (CDI) is important for improving disease outcomes and essential for transmission prevention. Guidelines define CDI as diarrhea (>= 3 unformed stools for at least 24 hours) in addition to either a positive CD stool test or presence of pseudomembranous colitis. One strategy to limit testing of asymptomatic patients is to reject formed stool samples. However, unformed stool samples caused by laxative use often are submitted for testing.
Methods: We conducted a retrospective review of patients with positive C.difficile PCR assay that were determined to be healthcare associated cases to identify other possible causes for diarrhea. Patients with healthcare associated CDI (HACDI) from 1/1/2014 to 3/31/2015 were identified and included in this review. Laxative use and CDI symptoms including diarrhea in the 24 hours before and after positive stool test were reviewed.
Results: During the study period 169 patients were identified to have HACDI at our institution. Forty five patients (27%) received a laxative agent in the 24 hour period prior to CD testing. Diarrhea had resolved in 20% of patients within 24 hours after stool testing; despite resolution of diarrhea, these patients were treated for CDI.
Conclusion: In addition to infection control measures and antimicrobial stewardship, provider and nursing education regarding appropriate testing are needed to curb CDI rates. Over a quarter of our patients received laxatives within 24 hours of testing, and 20% had no diarrhea 24 hours after testing, raising the possibility that these patients had asymptomatic CD colonization. Preventing inappropriate testing is important for two reasons: it can increase institutional CDI rates and cause potential harm associated with treating asymptomatic patients.
Leila Tehrani, PharmD, Pharmacy, Mayo Clinic Arizona, Phoenix, AZ and Maria Teresa Seville, MD, FSHEA, Infectious Diseases, Mayo Clinic Arizona, Phoenix, AZ