Timing of Antibiotic Therapy in Hospitalized Patients With Clostridium difficile Infection: A Single-Center Retrospective Cohort Study

Abstract

Introduction: The 2010 Infectious Diseases Society of America (IDSA) guidelines recommend that empirical treatment should be initiated as soon as the diagnosis of severe or complicated CDI is suspected. Based on these recommendations, we aimed to study whether early initiation of antibiotic therapy in hospitalized patients with CDI was associated with improved hospital based outcomes.Table 1: Baseline Characteristics: Early vs. Late Administration of AntibioticsTable 2: Outcomes for Early verus Late Administration of AntibioticsMethods: Setting: Single-center retrospective cohort study conducted at an acute care facility for the period of April 1, 2012 to December 31, 2014 Patients: Hospitalized adults with diarrhea that tested positive for CDI by polymerase chain reaction (PCR) assay, identified through the infection control committee's database. Exclusion criteria: Initiation of CDI therapy before hospitalization; lack of treatment for CDI; diagnosis and discharge from the emergency room; patients treated with intravenous metronidazole before diagnosis for non-CDI indications; and incomplete data. Definitions: Time of diagnosis was the time that the nurse received a positive diagnosis report from the microbiology lab. Treatment time was the time of antibiotic administration. In case of two antibiotics, the time of the first antibiotic was used. Median diagnosis-to-treatment time was used to separate “early” versus “late” antibiotic therapy. Severity and adherence was statified based on IDSA guidelines. Primary outcome: All cause in-hospital mortality. Secondary outcomes: Hospital length of stay (LOS), intensive care unit (ICU) LOS and CDI related surgery (ie. colectomy). Statistical Analysis: SPSS Version 19 Results: 341 cases were identified, 53 were excluded, 288 were analyzed. Diagnosis-to-treatment median time was 165 minutes. Early antibiotic therapy was associated with a non-statistically significant trend towards reduced hospital LOS (5.5 vs 7.2 days, p = 0.057), ICU LOS (1.2 vs 2.4 days, p = 0.07) and requirement for surgery (0% versus 2%, p = 0.08). There was no difference in hospital mortality between the two groups. Conclusion: Early initiation of antibiotic therapy had no effect on mortality in our cohort but was associated with a non-significant trend towards reduced hospital LOS, ICU LOS and less requirement for surgery. Our data indicate that further analysis is needed with a larger sample size to verify the importance of early administration of antibiotics on clinical outcomes in hospitalized patients with CDI.