title: Appropriateness of empiric therapy in patients with suspected Clostridium difficile infection.
abstract: OBJECTIVE
  The objective of this study was to test the hypothesis that many patients with suspected Clostridium difficile infection (CDI) receive inappropriate empiric therapy and/or receive continued therapy despite negative test results.
  
  
  METHODS
  We performed a 3 month prospective cohort study at the Cleveland Veteran Affairs Medical Center to assess the appropriateness of empiric CDI therapy for all patients with stool samples submitted for CDI testing. Empiric therapy for CDI was considered appropriate if patients with suspected CDI had findings suggestive of severe or complicated illness.
  
  
  RESULTS
  Of 251 patients tested for CDI, 53 (21%) received empiric treatment, including 45 (85%) treated with metronidazole and 8 (15%) treated with vancomycin. Of the 53 empirical therapy regimens, only 20 (38%) were deemed appropriate based on criteria for severe or severe, complicated CDI and 39 (74%) had negative laboratory testing for CDI. Twenty-one of 39 (54%) patients with negative testing were continued on therapy for three or more days despite the negative results. The key limitations of the study are the fact that it was conducted in a single institution and had a small sample size.
  
  
  CONCLUSIONS
  In our facility, empiric treatment for CDI was common and more than half of empirical treatment was deemed inappropriate because patients did not meet criteria for severe CDI. Because CDI therapy may be associated with adverse effects, there is a need for interventions to improve the appropriateness of empiric CDI treatment.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Saade
authors.forename: Abhishek
authors.initials: A
authors.lastname: Deshpande
authors.forename: Sirisha
authors.initials: S
authors.lastname: Kundrapu
authors.forename: Venkata C K
authors.initials: VC
authors.lastname: Sunkesula
authors.forename: Dubert M
authors.initials: DM
authors.lastname: Guerrero
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Jury
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
mesh_terms: D000368:Aged; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male