Treatment of Clostridioides difficile Infection and Non-compliance with Treatment Guidelines in Adults in 10 US Geographical Locations, 2013–2015

Abstract

IDSA/SHEA) guidelines describe recommended therapy for Clostridioides difficile infection (CDI). OBJECTIVE: To describe CDI treatment and, among those with severe CDI, determine predictors of adherence to the 2010 IDSA/SHEA treatment guidelines. DESIGN: We analyzed 2013-2015 CDI treatment data collected through the Centers for Disease Control and Prevention's Emerging Infections Program. Generalized linear mixed models were used to identify predictors of guideline-adherent therapy. PATIENTS: A CDI case was defined as a positive stool specimen in a person aged ≥ 18 years without a positive test in the prior 8 weeks; severe CDI cases were defined as having a white blood cell count ≥ 15,000 cells/μl. MAIN MEASURES: Prescribing and predictors of guideline-adherent CDI therapy for severe disease. KEY RESULTS: Of 18,243 cases, 14,257 (78%) were treated with metronidazole, 7683 (42%) with vancomycin, and 313 (2%) with fidaxomicin. The median duration of therapy was 14 (interquartile range, 11-15) days. Severe CDI was identified in 3250 (18%) cases; of 3121 with treatment data available, 1480 (47%) were prescribed guideline-adherent therapy. Among severe CDI cases, hospital admission (adjusted odds ratio [aOR] 2.48; 95% confidence interval [CI] 1.90, 3.24), age ≥ 65 years

Use of electronic health record data to identify hospital-associatedClostridioides difficileinfections: a validation study

“…CDI-specific antibiotic treatment is another candidate for retrospective CDI case identification. While historically, metronidazole was the preferred treatment for non-severe CDI, oral vancomycin (and/or the more expensive fidaxomicin) is now the recommended treatment in many situations (13, 14). Though oral vancomycin is used exclusively for CDI, prophylaxis is becoming more common, so using oral vancomycin administration as a proxy for CDI can also overestimate the number of cases (15).…”

Association between prevalence of laboratory-identified Clostridioides difficile infection (CDI) and antibiotic treatment for CDI in US acute-care hospitals, 2019

“…Novosad et al 16 analyzed 2013-2015 CDI treatment data collected through the CDC's Emerging Infections Program and identified low provider adherence (47%) to guideline-recommended therapy for severe CDI in outpatient settings. 17 Their findings on infrequent use of vancomycin monotherapy and fidaxomicin may reflect a lack of provider confidence in the improved efficacy of oral vancomycin and fidaxomicin over metronidazole, and concerns were raised that adherence could continue to be poor.…”

“…17 Their findings on infrequent use of vancomycin monotherapy and fidaxomicin may reflect a lack of provider confidence in the improved efficacy of oral vancomycin and fidaxomicin over metronidazole, and concerns were raised that adherence could continue to be poor. 16 Clinician awareness and implementation of treatment practices recommended in the updated IDSA/SHEA guidelines may take time, potentially causing a lag between issuance of guideline updates and changes in clinical practice. Following the release of the updated IDSA/SHEA guidelines, some clinicians have continued to advocate for the use of metronidazole as a first-line therapeutic option for patients with mild CDI who are at low risk of disease complications.…”

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

“…Over the past decade, major diagnostic and therapeutic advances have changed how the disease is managed, making it difficult for nonspecialists to update its optimal management. As a result, poor adherence to guidelines and heterogeneity in patient management have been reported [ 6 , 7 ].…”