Reduction in testing and change in testing algorithm associated with decrease in number of nosocomial Clostridioides (Clostridium) difficile infections

Cook, Paul P.; Nichols, Suzy; Coogan, Michael D.; Opera, Jackie; DeHart, Michelle

doi:10.1016/j.ajic.2019.12.028

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…This recommendation is in accordance with Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines ( 55 ). The rationale behind the recommendation is that patients taking laxatives may be asymptomatically colonized with C. difficile , resulting in unnecessary antibiotic treatment ( 56 – 58 ). Furthermore, some studies identified laxatives as a risk factor for developing CDIs or recurrent CDIs ( 59 – 61 ), and a recent study found that the proportions of severe CDIs were similar between patients taking and those not taking laxatives ( 62 ).…”

Section: Discussionmentioning

confidence: 99%

An Osmotic Laxative Renders Mice Susceptible to Prolonged Clostridioides difficile Colonization and Hinders Clearance

Tomkovich

Taylor

King

et al. 2021

mSphere

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Section: Discussionmentioning

confidence: 99%

An Osmotic Laxative Renders Mice Susceptible to Prolonged Clostridioides difficile Colonization and Hinders Clearance

Tomkovich

Taylor

King

et al. 2021

mSphere

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“…7 Multiple recent studies have demonstrated that clinical decision support incorporated into the electronic health record (EHR) can aid in reducing inappropriate C. difficile testing and overall hospitalonset CDI rate. [8][9][10][11][12][13][14] However, additional research has noted that clinicians often disregard such guidance and rely instead on clinical judgement and personal beliefs about CDI. 10,15,16 We implemented a series of clinical decision support interventions in the EHR from January 2018 to July 2019 with the goal of increasing appropriateness of C. difficile testing across our 3-hospital health system.…”

mentioning

confidence: 99%

In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

Karlovich

Sata

Griffith

et al. 2021

Infect. Control Hosp. Epidemiol.

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Objective: To determine the impact of electronic health record (EHR)–based interventions and test restriction on Clostridioides difficile tests (CDTs) and hospital-onset C. difficile infection (HO-CDI). Design: Quasi-experimental study in 3 hospitals. Setting: 957-bed academic (hospital A), 354-bed (hospital B), and 175-bed (hospital C) academic-affiliated community hospitals. Interventions: Three EHR-based interventions were sequentially implemented: (1) alert when ordering a CDT if laxatives administered within 24 hours (January 2018); (2) cancellation of CDT orders after 24 hours (October 2018); (3) contextual rule-driven order questions requiring justification when laxative administered or lack of EHR documentation of diarrhea (July 2019). In February 2019, hospital C implemented a gatekeeper intervention requiring approval for all CDTs after hospital day 3. The impact of the interventions on C. difficile testing and HO-CDI rates was estimated using an interrupted time-series analysis. Results: C. difficile testing was already declining in the preintervention period (annual change in incidence rate [IR], 0.79; 95% CI, 0.72–0.87) and did not decrease further with the EHR interventions. The laxative alert was temporally associated with a trend reduction in HO-CDI (annual change in IR from baseline, 0.85; 95% CI, 0.75–0.96) at hospitals A and B. The gatekeeper intervention at hospital C was associated with level (IRR, 0.50; 95% CI, 0.42-0.60) and trend reductions in C. difficile testing (annual change in IR, 0.91; 95% CI, 0.85–0.98) and level (IRR 0.42; 95% CI, 0.22–0.81) and trend reductions in HO-CDI (annual change in IR, 0.68; 95% CI, 0.50–0.92) relative to the baseline period. Conclusions: Test restriction was more effective than EHR-based clinical decision support to reduce C. difficile testing in our 3-hospital system.

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“…27,38 We speculate that the increased CA-CDI rates, particularly in younger commercially insured and older persons with only Medicare coverage, may be due to continued overutilization of antibiotics in the community, in addition to increasing use of nucleic acid amplification tests (NAATs), associated with increased CDI test positivity when used as a single test. 39 Although NAATs have been increasingly used for CDI testing in hospitals, the widespread implementation of antibiotic stewardship and also diagnostic stewardship programs may have indirectly resulted in less testing for CDI in hospitalized patients, 40,41 contributing to the decrease in HCA-CDI rates observed in our study and by others. This study had several limitations.…”

Section: Discussionmentioning

confidence: 73%

Trends in the incidence of Clostridioides difficile infection in adults and the elderly insured by Medicaid compared to commercial insurance or Medicare only

Olsen

Stwalley

Tipping

et al. 2022

Infect. Control Hosp. Epidemiol.

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Objective: Few data are available to quantify the Clostridioides difficile infection (CDI) burden in US adults depending on Medicaid insurance status; thus, we sought to contribute to this body of information. Methods: Retrospective cohort study to identify adults with codes for CDI from 2011 to 2017 in MarketScan commercial and Medicaid databases (for those aged 25–64 years) and the CMS Medicare database (for those aged ≥65 years). CDI was categorized as healthcare-facility–associated (HCA-CDI) and community-associated CDI (CA-CDI). CDI incidence rates were compared by year, insurer, and age group. Results: The overall CDI incidence in the elderly was 3.1-fold higher in persons insured by Medicare plus Medicaid than in those insured by Medicare only (1,935 vs 618 per 100,000 person years (PY)), and the CDI incidence was 2.7-fold higher in younger adults with Medicaid compared to commercial insurance (195 vs 73 per 100,000 PY). From 2011 to 2017, HCA-CDI rates declined in the younger Medicaid population (124.0 to 95.2 per 100,000 PY; P < .001) but were stable in those commercially insured (25.9 to 24.8 per 100,000 PY; P = .33). In the elderly HCA-CDI rates declined from 2011 to 2017 in the Medicare-only population (403 to 318 per 100,000 PY; P < .001) and the Medicare plus Medicaid population (1,770 to 1,163 per 100,000 PY; P < .002). Persons with chronic medical conditions and those with immunocompromising conditions insured by Medicaid had 2.8- and 2.7-fold higher CDI incidence compared to the commercially insured population, respectively. The incidence of CDI was lowest in Medicaid and commercially insured younger adults without chronic medical or immunosuppressive conditions (67.5 and 45.6 per 100,000 PY, respectively). Conclusions: Although HCA-CDI incidence decreased from 2011 to 2017 in elderly and younger adults insured by Medicaid, the burden of CDI remains much higher in low-income adults insured by Medicaid.

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Reduction in testing and change in testing algorithm associated with decrease in number of nosocomial Clostridioides (Clostridium) difficile infections

Cited by 7 publications

References 11 publications

An Osmotic Laxative Renders Mice Susceptible to Prolonged Clostridioides difficile Colonization and Hinders Clearance

An Osmotic Laxative Renders Mice Susceptible to Prolonged Clostridioides difficile Colonization and Hinders Clearance

In pursuit of the holy grail: Improving C. difficile testing appropriateness with iterative electronic health record clinical decision support and targeted test restriction

Trends in the incidence of Clostridioides difficile infection in adults and the elderly insured by Medicaid compared to commercial insurance or Medicare only

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