Reducing delays in the diagnosis and treatment of Clostridium difficile diarrhoea.
BACKGROUND
The diagnosis of Clostridium difficile diarrhoea is often delayed.


OBJECTIVE
To assess and reduce delays in diagnosis and treatment.


METHODS
Two-part study: retrospective audit then prospective observational.


METHODS
The retrospective study audited cases positive for C. difficile culture or toxin A between June 2000 and January 2001. Cases were reviewed regarding demographic characteristics and the timing from onset of symptoms to testing and treatment (n = 27). In the prospective study, efforts were made to increase the awareness of medical staff about C. difficile diarrhoea, and testing for C. difficile toxin A assay was substituted for stool culture and external toxin analysis. Data were prospectively analysed for demographic characteristics and time from onset of symptoms to testing and treatment (n = 24).


RESULTS
There were no significant differences in age (76 vs. 78 years), male to female ratio (1:2 vs. 1:4), reason for admission, specialty responsible, or mortality rate (40% vs. 37%) during the presenting admission. Preceding antibiotic use, the combination of antibiotics used and subsequent treatment also did not differ between groups. The time from onset of diarrhoea to sampling was reduced from 4.7 days (range 3-30) to 0.8 days (range 0-5; p </= 0.05). The time from sampling to treatment was reduced from 7.7 days (5-34) to 2.8 days (2-9; p </= 0.05).


CONCLUSIONS
The combination of increased awareness of C. difficile diarrhoea and the change to in-house toxin testing significantly reduced the time from onset of symptoms to sampling and treatment.
Frenz
M B
MB
Department of Gastroenterology, Wycombe Hospital, High Wycombe, UK. mfrenz@doctors.org.uk
McIntyre
A S
AS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D003967:Diarrhea / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D004359:Drug Therapy, Combination; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000900:Anti-Bacterial Agents