Outcome of Electronic Order Alert Intervention Relative to Toxigenic Clostridium difficile PCR Analysis and Hospital-Onset C difficile Infection in a Multihospital Health Care System

Munson, Erik; Rodriguez, Sonia; Riederer, Nancy; Munson, Kimber L.; Block, Denise; Land, Gayle; Stone, Rosalyn; Villalobos, Aurora; Block, Timothy K.

doi:10.1093/ajcp/aqz022

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…C. difficile is transferred by the faecal-oral route. The common risk factors of CDI and the clinical symptoms are antimicrobial therapy, old age and high fever with various degrees of diarrhea and possibly life-threatening colitis [ 3 ]. Different assays can used to diagnose and detect CDI, but no single assay confirms CDI [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Extraintestinal Clostridioides difficile infection

Zhen

Juan

Yang

et al. 2020

IDCases

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Clostridioides (Clostridium) difficile is the major cause of healthcare antibiotic-associated diarrhoea. However, extra-intestinal manifestations of Clostridioides (Clostridium) difficile infection (CDI) (including bacteremia and tissue infection) are extremely rare. We report a case of extraintestinal CDI after surgery. The isolate of C. difficile was not the PCR ribotype 027. However, this isolate produced toxins A and B. The patient underwent a follow-up examination 30 days after discharge, which showed complete recovery. This case report adds to existing knowledge of CDI.

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Section: Introductionmentioning

confidence: 99%

Extraintestinal Clostridioides difficile infection

Zhen

Juan

Yang

et al. 2020

IDCases

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The Impact of Clinical Decision Support Alerts onClostridioides difficileTesting: A Systematic Review

Dunn

Radakovich

Ancker

et al. 2020

Clinical Infectious Diseases

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Background Several studies have investigated the utility of electronic decision support alerts in diagnostic stewardship for Clostridioides difficile infection (CDI). However, it is unclear if alerts are effective in reducing inappropriate CDI testing and/or CDI rates. The aim of this systematic review was to determine if alerts related to CDI diagnostic stewardship are effective at reducing inappropriate CDI testing volume and CDI rates among hospitalized adult patients. Methods We searched Ovid Medline and 5 other databases for original studies evaluating the association between alerts for CDI diagnosis and CDI testing volume and/or CDI rate. Two investigators independently extracted data on study characteristics, study design, alert triggers, cointerventions, and study outcomes. Results Eleven studies met criteria for inclusion. Studies varied significantly in alert triggers and in study outcomes. Six of 11 studies demonstrated a statistically significant decrease in CDI testing volume, 6 of 6 studies evaluating appropriateness of CDI testing found a significant reduction in the proportion of inappropriate testing, and 4 of 7 studies measuring CDI rate demonstrated a significant decrease in the CDI rate in the postintervention vs preintervention period. The magnitude of the increase in appropriate CDI testing varied, with some studies reporting an increase with minimal clinical significance. Conclusions The use of electronic alerts for diagnostic stewardship for C. difficile was associated with reductions in CDI testing, the proportion of inappropriate CDI testing, and rates of CDI in most studies. However, broader concerns related to alerts remain understudied, including unintended adverse consequences and alert fatigue.

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Improving Appropriate Diagnosis of Clostridioides difficile Infection Through an Enteric Pathogen Order Set With Computerized Clinical Decision Support: An Interrupted Time Series Analysis

Liu

Lan

Krantz

et al. 2020

Open Forum Infectious Diseases

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Background Inappropriate testing for Clostridioides difficile (C. difficile) leads to overdiagnosis of C. difficile infection (CDI). We determined the effect of a computerized clinical decision support (CCDS) order set on C. difficile PCR test utilization and clinical outcomes. Methods An interrupted time series analysis comparing C. difficile PCR test utilization, hospital-onset CDI rates, and clinical outcomes before and after implementation of a CCDS order set at 2 academic medical centers, University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC). Results Compared with the 20-month pre-intervention period, during the 12-months post-implementation of the CCDS order set, there was an immediate and sustained reduction in C. difficile PCR test utilization rates at both hospitals (HMC: -28.2%, [95%CI -43.0%, -9.4%], p=.005; UWMC: -27.4%, [95%CI, -37.5%, -15.6%], p &.001). There was a significant reduction in rates of C. difficile tests ordered in the setting of laxatives (HMC: -60.8%, [95%CI -74.3%, -40.1%], p &0.001; UWMC: -37.3%, [95% CI, -58.2%, -5.9%], p=.02). The intervention was associated with an increase in the C. difficile test positivity rate at HMC (p =.01). There were no significant differences HO-CDI rates or in the proportion of patients with HO-CDI who developed severe CDI or CDI-associated complications including ICU transfer, extended length of stay, 30-day mortality, and toxic megacolon. Conclusions CCDS tools can improve C. difficile diagnostic test stewardship without causing harm. Additional studies are needed to identify key elements of CCDS tools to further optimize C. difficile testing and assess their effect on adverse clinical outcomes.

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Outcome of Electronic Order Alert Intervention Relative to Toxigenic Clostridium difficile PCR Analysis and Hospital-Onset C difficile Infection in a Multihospital Health Care System

Cited by 3 publications

References 25 publications

Extraintestinal Clostridioides difficile infection

Extraintestinal Clostridioides difficile infection

The Impact of Clinical Decision Support Alerts onClostridioides difficileTesting: A Systematic Review

Improving Appropriate Diagnosis of Clostridioides difficile Infection Through an Enteric Pathogen Order Set With Computerized Clinical Decision Support: An Interrupted Time Series Analysis

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