Adherence to clinical practice guidelines for the management of Clostridium difficile infection in Japan: a multicenter retrospective study

Abstract

This study was conducted to investigate the adherence to clinical practice guidelines (CPGs) for Clostridium difficile infection (CDI). A retrospective multicenter observational study was conducted via chart review at four teaching hospitals in Japan from April 2012 through September 2013. CDI was diagnosed based on positive identification of CD toxin by enzyme immunoassay testing. CDI patients were divided into non-severe and severe groups according to the severity criteria of four published guidelines (SHEA/IDSA 2010, ACG 2013, ESCMID 2009, HPA/DH 2008). Three parameters were assessed in association with disease severity: adherence to treatment guidelines, prognosis, and relapse rate. In total, 170 patients were diagnosed with CDI (1.04 cases per 10,000 patient-days). The 30-day all-cause mortality and recurrence rates were 13% and 14%, respectively. CPGs adherence ranged from 52% to 70% in the non-severe group and from 8.5 to 23% in the severe group (P < 0.01). Among severe CDI patients, no significant difference in mortality or recurrence was found between the patients whose treatments adhered and did not adhere to the CPGs. CPGs adherence was low, especially for patients with severe CDI. Improved guideline adherence and more accurate definitions of severity based on prognosis are needed for appropriate CDI management.

Excess length of hospital stay, mortality and cost attributable to Clostridioides (Clostridium) difficile infection and recurrence: a nationwide analysis in Japan

“…There are no estimates of CDI-attributable mortality in Japan that are directly comparable to our study. Other studies have reported an all-cause, 30-day mortality rate of 3.4-15.1% in patients with CDI [13,[25][26][27][28][29][30]. In our study, the all-cause hospital mortality in the CDI hospitalisation rate was 22.1%, which was higher than previously reported from Japan but similar to the hospital mortality in the US study of patients with sepsis (24.0%).…”

Clostridioides (Clostridium) difficile infection in Japanese hospitals 2008–2017: A real-world nationwide analysis of treatment pattern, incidence and testing density

“…Nevertheless, the CDI incidence rate in our study is similar to that reported by a number of other Japanese studies, ranging from 0.8 to 1.6/10,000 patient-days [12,16,32,33]. One of these studies, conducted at four Japanese teaching hospitals, also reported a testing density (24.03/10,000 patient-days) that was consistent with our rate of 24.45/10,000 patient-years at study end [16]. Note that the nucleic acid amplification test (NAAT) was not reimbursed at the time of the study, and we did not identify the type of EIA (i.e.…”

“…A systematic review of published data from 2006 to 2017 found several evidence gaps including information on the treatments used for CDI (for example type, dose and duration) [11]. Most studies investigating CDI treatment in Japan have been conducted at single centers [12e15] or a limited number of hospitals [16,17], providing snapshots of CDI in certain patient subgroups rather than comprehensive reporting of trends in hospital-onset CDI over time. Therefore, up-to-date information about the treatment and diagnostic landscape of hospital-acquired CDI in Japan remains limited.…”

The Epidemiology of Clostridium difficile Infection in Japan: A Systematic Review

“…Another large-scale outpatient study ( n = 2193) reported the incidence of community-acquired CDI as 1.4/100,000 patient-years (or 0.14/10,000 patient-years) [ 19 ], and a study of both actively tested in- and outpatients provided an incidence of 0.8 cases/10,000 patient-days [ 20 ]. A retrospective cohort study based on chart reviews at four tertiary care hospitals reported 160 patients aged at least 14 years with hospital-onset CDI, as defined according to clinical practice guidelines, giving an incidence of 1.04/10,000 patient-days (or 1.61/1000 admissions) [ 21 ]. The low incidence of hospital-onset CDI compared with that reported in studies from Western countries was suggested by the authors to be a consequence of the different strains prevalent in different regions, with outbreaks of hospital-acquired CDI in Western countries being attributed to highly virulent strains that are not prevalent in Japan.…”

“…The study did not explore the strains responsible for the CDI episodes at the four hospitals. The authors also suggested that the low frequency of CDI may be a consequence of the low frequency of testing for C. difficile [ 21 ].…”