Methods: The CCDS was designed to identify patients with a prevented test if a provider initiated the CCDS and aborted the order. Outcomes of patients with either a prevented or negative nucleic acid amplification test (NAAT) were compared retrospectively. A logistic regression model was created to evaluate the association between a prevented test attempt and serious adverse events. Patients with a subsequent positive result within 7d of the initial trigger and those treated with CDI-effective antibiotics underwent chart review.
Results: Multivariate analysis of 637 cases (490 negative, 147 prevented) showed that a prevented test was not associated with the primary composite outcome (inpatient mortality or ICU-transfer) compared to a negative test (adjusted odds ratio, 0.912; 95%CI 0.513-1.571). Prevented tests were associated with shorter length of stay and similar rates of CDI-related complications. Eleven (7.5%) had a subsequent positive CDI, four within 30 minutes of the prevented test, suggesting non-significant delay in testing. Of the remaining 7 patients, case review confirmed that 5 did not meet testing criteria while 2 met testing criteria at the time of the prevented test. No serious adverse events attributable to delayed CDI diagnoses or unjustified CDI treatment were identified by individual case review.
Conclusion: CCDS-based diagnostic stewardship for CDI may be both a safe and effective means to reduce inappropriate testing.
C. Sifri, None