Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study

Ali Elbeddini

doi:10.11648/j.ijidt.20180303.12

Abstract

Clostridium difficile infection (CDI) is responsible for 15 – 25% cases of health-care associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval and duration indicated based on the disease severity and episode within 24 hours of diagnosis. In addition, our study also described the population and their risk factors for CDI at our hospital. This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st 2017 to June 30th 2018. Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild to moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months. The use of a PPI in this study, a modifiable risk factor without a clear indication was 35%. The conclusion was that there is an area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.

Highlights

The first primary objective of this study is to describe the Clostridium difficile infections (CDI) treatment adherence at WDMH to the WDMH C. difficile treatment algorithm, which is based on the Infectious Diseases Society of America (IDSA) 2010 C. difficile guidelines
Treatment adherence was based on he CDI treatment initiated and disease severity listed in the algorithm including hypotension defined as SBP < 90 mmHg and measured white blood cell (WBC) count within the 24 hours of diagnosis
The reasons cases were excluded were the following: four cases had a negative stool test result and no colonoscopy done, four cases had a negative polymerase chain reaction (PCR) test and no colonoscopy, two cases did not receive treatment for CDI, two cases identified in the emergency room and were not admitted, two cases were already discharged by the time the results came back, and one case was on a vancomycin taper initiated from another institution

Summary

Introduction

[2] Other risk factors associated with an increased exposure to C. difficile and antibiotic use include gastrointestinal surgery, irritable bowel disease, diabetes, cardiovascular, respiratory or kidney disease, patients over 65 year old, use of nasogastric tubes, prolonged hospitalization or exposure to long term care facilities. [5] appropriate treatment of CDI based on the severity of the infection will help decrease the risk of developing a recurrent CDI. Severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months.

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