Death Rate Higher In C.diff Patients Who Do Not Receive Guideline-Adherent Therapy Interview with:

Dr. Shannon Novosad, MD Epidemic Intelligence Service, CDC Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases

Dr. Shannon Novosad

Dr. Shannon Novosad, MD
Epidemic Intelligence Service, CDC
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases What is the background for this study? What are the main findings?

Response: Clostridium difficile can cause an infection in the colon called colitis. Symptoms include diarrhea, fever, nausea, and abdominal pain. It is an important cause of healthcare associated infections with approximately half a million C. difficile infections and 29,000 associated deaths in 2011. The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America published guidelines in 2010 advising clinicians on appropriate antibiotic regimens to treat C. difficile infection.  Prior studies have found that provider adherence to these guidelines, particularly in those with severe disease, is poor.  However, these studies primarily involved patients treated at a single healthcare facility. We were interested in examining CDI treatment practices in a larger group of patients with C. difficile infection located across geographically diverse areas. Further we wanted to learn more about what patient characteristics might be associated with receiving guideline-adherent therapy for C. difficile infection.

We used data from the Center for Disease Control and Prevention’s Emerging Infections Program (EIP) which performs active population and laboratory-based surveillance for C. difficile infections in 10 U.S. sites and examined how 11,717 patients including 2006 with severe disease were treated. We found that provider adherence to national treatment guidelines was low with only around 40% of those with severe disease being prescribed the appropriate antibiotic treatment. Our analysis suggests that those who were tested for C. difficile in the hospital or who were admitted to the hospital around the time of diagnosis were more likely to receive recommended antibiotic therapy.

In addition, patients greater than 65 years old or with more underlying comorbidities were more likely to receive the right antibiotic treatment. We also found that after adjusting for age and underlying comorbidities, the odds of death within 30 days of diagnosis was almost 400% higher in patients who did not receive guideline-adherent therapy compared to those who did. What should readers take away from your report?

Response:  Despite the availability of national treatment guidelines since 2010, provider adherence to these guidelines is low particularly among patients with severe disease. Efforts to improve provider adherence to recommended treatment practices may improve outcomes in patients with severe C. difficile infection. What recommendations do you have for future research as a result of this study?

Response: Further efforts are needed to better understand factors that impact provider adherence to recommendations for C. difficile treatment. Effective interventions to improve provider adherence to national treatment guidelines are ultimately needed. Thank you for your contribution to the community.

Citation: ID Week abstract
Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016

Treatment of Clostridium difficile Infection in 10 U.S. Geographical Locations, 2013-2014

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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