• Shannon A Novosad, Yi Mu, Lisa G Winston, Helen Johnston, Elizabeth Basiliere, Danyel M Olson, Monica M Farley, Andrew Revis, Lucy Wilson, Rebecca Perlmutter, Stacy M Holzbauer, Tory Whitten, Erin C Phipps, Ghinwa K Dumyati, Zintars G Beldavs, Valerie L S Ocampo, Corinne M Davis, Marion Kainer, Dale N Gerding, and Alice Y Guh.
• Division of Healthcare Quality Promotion, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA. ydz1@cdc.gov.
• J Gen Intern Med. 2020 Feb 1; 35 (2): 412-419.

BackgroundInfectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines describe recommended therapy for Clostridioides difficile infection (CDI).ObjectiveTo describe CDI treatment and, among those with severe CDI, determine predictors of adherence to the 2010 IDSA/SHEA treatment guidelines.DesignWe 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.PatientsA 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 MeasuresPrescribing and predictors of guideline-adherent CDI therapy for severe disease.Key ResultsOf 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 (aOR 1.37; 95% CI 1.10, 1.71), Charlson comorbidity index ≥ 3 (aOR 1.27; 95% CI 1.04, 1.55), immunosuppressive therapy (aOR 1.21; 95% CI 1.02, 1.42), and inflammatory bowel disease (aOR 1.56; 95% CI 1.13, 2.17) were associated with being prescribed guideline-adherent therapy.ConclusionsProvider adherence to the 2010 treatment guidelines for severe CDI was low. Although the updated 2017 CDI guidelines, which expand the use of oral vancomycin for all CDI, might improve adherence by removing the need to apply severity criteria, other efforts to improve adherence are likely needed, including educating providers and addressing barriers to prescribing guideline-adherent therapy, particularly in outpatient settings.

15 keywords...

hide…