Abstract
ObjectivesClostridium 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 h of diagnosis. Furthermore, our study also described the population and their risk factors for CDI at our hospital.MethodsThis 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. Cases were identified by a positive stool test along with watery diarrhea or by colonoscopy.ResultsSixty 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 3 months. The use of a PPI in this study, a modifiable risk factor without a clear indication, was 35%.ConclusionAn 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
Clostridium difficile is an anaerobic, spore producing, gram-positive bacterium that is transmitted fecal-orally [1]
In severe C. difficile infections (CDI), which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%)
Primary research objectives The first primary objective of this study is to describe the CDI treatment adherence at Winchester District Memorial Hospital (WDMH) to the WDMH C. difficile treatment algorithm, which is based on the Infectious Diseases Society of America (IDSA) 2010 C. difficile guidelines
Summary
Background Clostridium difficile is an anaerobic, spore producing, gram-positive bacterium that is transmitted fecal-orally [1]. CDI rates tend to be higher between the months of November to March due to increased respiratory infections requiring use of antibiotics [3]. The rate of recurrence after an initial episode of CDI is 6–25% and Elbeddini and Gerochi J of Pharm Policy and Pract (2021) 14:19 increases with recurrent episodes of CDI [1, 4]. It can be manifested either by another infection caused by the original strain of C. difficile or a new infection caused by a new strain of C. difficile, while the microflora in the colon is returning to normal levels [1]. Since September 2008, C. difficile infections (CDI) are one of several monthly patient safety indicators reportable to the Ontario Ministry of Health and Long-Term Care (MOHLTC) under the Public Hospitals Act [3]
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