2124. Treatment of Clostridium difficile Infection in 10 U.S. Geographical Locations, 2013-2014
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Background: In 2011, there were approximately half a million Clostridium difficile infections (CDIs) and 29,000 associated deaths. The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) published CDI treatment guidelines in 2010. To our knowledge, provider adherence to recommendations has only been assessed in limited single center studies. We sought to describe CDI treatment across geographically diverse areas and assess adherence to current guidelines.

Methods: Active population-based CDI surveillance was conducted in 10 U.S. sites. A case was defined as a positive C. difficile toxin or molecular assay on a stool specimen from a person ≥18 years old without a positive test in the prior 8 weeks during 2013-2014. Demographics, comorbidities, outcomes, and treatment data were collected. Based on available information, severe disease was defined as white blood cell ≥15,000/µl.

Results: Of 13,202 cases with data available, 11,717 (89%) were treated for CDI. The proportion that were female (62% vs 60%), aged ≥65 years (47% vs 44%), or had Charlson comorbidity index >2 (32% vs 29%) was similar between the treated and untreated cases. Of treated cases, 6793 (58%) received only metronidazole, 2189 (19%) received only vancomycin, and 2482 (21%) received both. Most (81%) were prescribed therapy within 2 days of diagnosis. Of those treated with only metronidazole, 81% received the recommended dosage and frequency but only 62% were treated for at least 10 days. Of 2041 severe cases, 2006 (98%) were treated; however, only 36% received vancomycin consistent with current IDSA/SHEA guidelines. A greater proportion of untreated cases died compared to the treated cases (11% vs 2%, p<.0001). Among severe cases that were treated, a greater proportion treated with non-guideline-adherent therapy died compared to those with adherent therapy (9% vs 2%, p<.0001).

Conclusion: The majority of patients with CDI were promptly treated following diagnosis. However, adherence to recommended therapy was low and mortality with non-guideline-adherent therapy was increased among patients with severe disease. Efforts to improve provider adherence to treatment guidelines could lead to improved CDI patient outcomes.

Shannon Novosad, MD, MPH1, Lisa G. Winston, MD2, Helen Johnston, MPH3, Elizabeth Badolato, AAS3, Carol Lyons, MS, MPH4, Monica Farley, MD, FIDSA5, Andrew Revis, MPH6, Lucy Wilson, MD, ScM7, Rebecca Perlmutter, MPH7, Stacy M. Holzbauer, DVM, MPH8, Tory Whitten, MPH9, Erin C. Phipps, DVM, MPH10, Ghinwa Dumyati, MD, FSHEA11, Zintars G. Beldavs, MS12, Valerie L.S. Ocampo, RN, MIPH12, Marion Kainer, MBBS, MPH, FSHEA13, Corinne M. Davis, MPH, MS13, Jamie Barnes, MPH14, Dale Gerding, MD, FIDSA15 and Alice Guh, MD, MPH1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)University of California, San Francisco, School of Medicine, Department of Medicine, San Francisco, CA, (3)Colorado Department of Public Health and Environment, Denver, CO, (4)Yale School of Public Health, Connecticut EIP, New Haven, CT, (5)Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, GA, (6)Georgia EIP, Research and Education Foundation, Decatur, GA, (7)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (8)CDC, St. Paul, MN, (9)Infectious Disease Epidemiology, Prevention, and Control Division, Minnesota Department of Health, St. Paul, MN, (10)New Mexico Emerging Infections Program, Albuquerque, NM, (11)University of Rochester Medical Center, Rochester, NY, (12)Oregon Health Authority, Portland, OR, (13)Tennessee Department of Health, Nashville, TN, (14)Centers for Disease Control and Prevention, Atlanta, GA, (15)Hines VA Hospital, Hines, IL

Disclosures:

S. Novosad, None

L. G. Winston, None

H. Johnston, None

E. Badolato, None

C. Lyons, None

M. Farley, None

A. Revis, None

L. Wilson, None

R. Perlmutter, None

S. M. Holzbauer, None

T. Whitten, None

E. C. Phipps, None

G. Dumyati, None

Z. G. Beldavs, None

V. L. S. Ocampo, None

M. Kainer, None

C. M. Davis, None

J. Barnes, None

D. Gerding, None

A. Guh, None

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