227 A Retrospective Evaluation of Compliance to Clostridium difficile Treatment Guidelines

Abstract

INTRODUCTION: Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released by the Centers for Disease Control and Prevention (CDC). Studies indicate that C. diff. has become the most common microbial cause of Healthcare-Associated Infections found in U.S. hospitals driving up healthcare costs in acute care facilities alone. Our goal with this study is to investigate via retrospective chart review over the past 12 months to find out how often proper treatment was administered for patients admitted with a diagnosis of C. diff. infection. METHODS: This study is a retrospective chart review on patients admitted between Feb 2018–Feb 2019 at Franciscan Health St James Olympia Fields. Subjects were randomly selected with ICD-10 code for CDI. Age, gender, comorbidities, admission laboratory values, admission and discharge dates, and clinical course were obtained from EMR. The compliance to guidelines was assessed at initial treatment and as subjects further stratified into the categories non-severe, severe and fulminant disease. Compliance to guidelines was determined by type and duration of therapy. Secondary endpoints such as clinical outcomes such as 90-day mortality, therapy escalation and clinical cure which were also evaluated. RESULTS: A total of 118 patients were included in this study. This study shows that physician adherence to evidence-based guidelines for treatment of CDI was poor (50%). The study also found that compliance was lower in subjects with severe and fulminant disease. Overall, mortality associated with Clostridium Difficile treatment was 19.4% across all patients diagnosed with CDI regardless of severity of illness. CONCLUSION: CDI is a highly morbid condition and places a heavy burden on the healthcare system. Failing to adhere to the guidelines for treatment of Clostridium Difficile is detrimental to patients and results in worse clinical outcomes. This study identified that compliance to treatment guidelines is poor and barriers to compliance still exist despite education and guideline availability. To improve compliance to treatment guidelines in our hospital, we are currently developing an electronic order set through EPIC based on guidelines to allow for accurate treatment delivery and provide better outcomes.