2096. Clostridium Difficile, Evaluation of Testing Practices, non C. Difficile Antibiotic Use and Implications for the Clinical Practice
Session: Poster Abstract Session: Clostridium difficile: Outcomes, Testing, Prevention
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • final-poster-idsa-cdiff-2016.png (1.1 MB)
  • Background: Clostridium difficile remains leading cause of healthcare associated infection despite evidence based intervention to prevent it. This quality improvement project evaluates appropriateness of indication for testing, management based upon severity, use of non CDI antibiotics before and after CDI diagnosis so as to develop strategy to decrease over diagnosis and improve antibiotic use to prevent CDI.

    Methods: Retrospective cohort study of CDI from 2014 to 2015 in South Texas Veteran Health Care System (STVHCS). Laboratory confirmed cases of CDI diagnosed as hospital onset, hospital associated (HO- HA CDI) cases by infection control were selected.

    We analyzed all cases for indication of CDI stool testing (documented 3 loose stools/ 24 hour or loose stools with abdominal pain), other potential cause of diarrhea, appropriateness of use of non-CDI antibiotics within 30 days before and 90 days after onset of CDI based on treatment duration and treatment received for CDI based on severity (mild disease-metronidazole, moderate to severe disease- vancomycin).

    Results: 73 patients were diagnosed with HO-HA CDI. 42% patients had severe CDI. All received specific anti-CDI antibiotics but only 82% of patients were treated appropriately for severity. 24.7% did not meet criteria for CDI testing. 6.8% had no documentation of indication. 68.4% had other potential causes for loose stools e.g., stool softener, laxatives.

    Non CDI antibiotic duration before CDI diagnosis was appropriate on 61.6% of the cases. Mean duration of treatment was 6.4 (±15.9) days. Non CDI antibiotic duration post CDI was appropriate on 15.1% of the cases. Mean duration of treatment was 16.2 (±20) days.

    Conclusion: This study showed that over diagnosis of clostridium difficile infection is a concerning health care problem. C difficile PCR test is overly sensitive and may detect colonized patients. Inappropriate testing of CDI without proper indication can over estimate disease burden. Excessive use of antibiotics before and after CDI diagnosis needs to be corrected by improving compliance with current guidelines for proper antibiotic duration. Educational campaigns, compliance with CDI treatment guidelines and algorithms will be crucial for decreasing rates of CDI at the STVHCS.

    Victor Cepeda, MD1, Prakash Shrestha, MD2, Kelly Echevarria, Pharm.D,.BCPS, AQ-ID3, Courtney Ortiz, Pharm.D., BCPS3, Hilda Ben, BSN, RN, CIC4 and Jose Cadena, MD/ID5, (1)Internal Medicine, University of Texas Health Science Center at San Antonio, San antonio, TX, (2)Infectious Diseases, University of Texas Health Science Center at San Antonio, San antonio, TX, (3)Pharmacy Service, South Texas Veterans Health Care System, San Antonio, TX, (4)Office of Infection Control and Prevention, South Texas Veterans health care system, San Antonio, TX, (5)Medicine/Infectious Diseases, South Texas Veterans Healthcare System, San antonio, TX

    Disclosures:

    V. Cepeda, None

    P. Shrestha, None

    K. Echevarria, None

    C. Ortiz, None

    H. Ben, None

    J. Cadena, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.