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.
K. Echevarria, None
C. Ortiz, None
H. Ben, None
J. Cadena, None
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