Impact of a Healthcare Provider Educational Intervention on Frequency ofClostridium difficilePolymerase Chain Reaction Testing in Children: A Segmented Regression Analysis

Abstract

Healthcare provider education can cost-effectively reduce the frequency of C difficile testing and CDI misdiagnosis by improving test utilization among low-risk children.

Implementation of Rapid Molecular Infectious Disease Diagnostics: the Role of Diagnostic and Antimicrobial Stewardship

“…Targeted educational interventions can be used to reduce overutilization among providers and trainees who are high test users, as has been demonstrated for Clostridium difficile PCR testing in pediatric populations (17,18). Provider education is most effective when conducted as one component of a multifaceted approach to diagnostic stewardship.…”

Healthcare provider diagnostic testing practices for identification of Clostridioides (Clostridium) difficile in children: an Emerging Infections Network survey

“…The AAP-endorsed age-based restrictions of C. difficile testing were adopted by the updated IDSA/SHEA guideline. 4 Age-based testing restrictions, the uptake of which may be improved with electronic order entry messaging, 7,8 may improve testing decisions and reduce unnecessary antibiotic therapy for C. difficile carriage, leading to reduced healthcare costs. 7,9 However, reducing unnecessary testing in older children may be more challenging.…”

“…4 Age-based testing restrictions, the uptake of which may be improved with electronic order entry messaging, 7,8 may improve testing decisions and reduce unnecessary antibiotic therapy for C. difficile carriage, leading to reduced healthcare costs. 7,9 However, reducing unnecessary testing in older children may be more challenging. While the vast majority of respondents report that C. difficile testing is restricted for formed stools submitted to the laboratory, this does not prevent testing in children with clinically insignificant diarrhea (i.e., 2 or fewer unformed stools in 24 hours) or diarrhea in patients who are unlikely to have CDI.…”

“…While the vast majority of respondents report that C. difficile testing is restricted for formed stools submitted to the laboratory, this does not prevent testing in children with clinically insignificant diarrhea (i.e., 2 or fewer unformed stools in 24 hours) or diarrhea in patients who are unlikely to have CDI. In these cases, pediatric healthcare provider education 7 and/or leveraging the electronic health record 9 to monitor frequency of diarrhea and recent laxative use may be effective. Of note, while this definition of clinically significant diarrhea has not been validated in children, this definition is recommended in the AAP CDI clinical care guidelines.…”

Strategies for Optimizing the Diagnostic Predictive Value of Clostridium difficile Molecular Diagnostics

“…Furthermore, in our pediatric population, inappropriate C. difficile testing was performed frequently in children with communityonset diarrhea (14). Based on these data at our children's hospital, we implemented an intervention incorporating education of health care providers regarding the limitations of NAATs in children and an EHR alert to clinicians ordering C. difficile PCR testing (22). This alert cautioned against ordering C. difficile PCR in children at low risk of CDI, such as those in the following categories: children without CDI risk factors and with vomiting as a significant complaint (i.e., children more likely to have a viral diarrheal illness); children without clinically significant diarrhea; children with recent laxative use; children whose diarrhea resolved after recent treatment (i.e., avoiding "test of cure"); and children with a negative PCR result from the previous 7 days.…”