Impact of an Intervention Program on Clostridioides difficile Infections: Comparison of 2 Hospital Cohorts

Abstract

Background Clostridioides difficile infection (CDI) occurs in various contexts and care settings and is managed by multiple specialists who are not experts in its management. While there are many initiatives to improve the diagnosis and avoid overdiagnosis, there is less focus on the overall management of the infection. Methods We studied a cohort of patients with a positive test for toxigenic C. difficile in two hospitals. Hospital A has a program that provides advice from an infectious disease specialist (IDS) and promotes continuity of care by providing a phone number to contact the IDS. Hospital B does not have any specific CDI program. The evaluation assessed the proportion of patients not treated (carriers or self-limited disease), adherence to IDSA guidelines, access to novel therapies, recurrence and mortality rates, readmission and emergency department visits due to CDI. We assessed the program's effectiveness through a logistic regression model adjusted for covariates chosen by clinical criteria. Results Hospital A avoided more unnecessary treatments (19.3% vs. 11.5%), provided access to novel therapies more frequently (35.3% vs. 13%) and adhered more closely to current guidelines (95.8% vs. 71.3%). Although the mortality and recurrence rates did not differ, the absence of an intervention program was associated with greater odds of admission due to recurrence (OR 4.19, p=0.037) and more visits to the emergency department due to CDI (OR 8.74, p=0.001). Conclusions Implementation of a CDI intervention program based on recommendations from infectious disease specialists, and improved access to specialized care during the follow-up, is associated with enhanced quality of CDI management and potential reductions in hospital resource utilization.