title: Effect of treatment variation on outcomes in patients with Clostridium difficile.
abstract: OBJECTIVE
  New guidelines for the treatment of Clostridium difficile-associated diarrhea were published by the Infectious Disease Society of America (IDSA) in 2010, however, there has been no literature evaluating the effectiveness of these guidelines. The purpose of this study was to examine the clinical outcomes of Clostridium difficile infection including death, C difficile infection recurrence, toxic megacolon, and surgery between patients who received guideline-concordant therapy vs guideline-discordant therapy.
  
  
  METHODS
  Retrospective case-control study of hospitalized adults with C difficile infection presenting to a 420-bed tertiary care referral county teaching hospital. Patients were identified by International Classification of Diseases-9th Revision codes, and included if they were ≥18 years of age and treated for C difficile infection during their hospital visit. Complication rates (death, infection recurrence, toxic megacolon, and surgery) of patients with C difficile infection were measured to determine if following the IDSA guidelines improves outcomes.
  
  
  RESULTS
  Only 51.7% of the patients' prescribers followed the 2010 IDSA guidelines. Patients whose prescribers followed the IDSA guidelines experienced fewer complications than patients whose prescribers strayed from the guidelines (17.2% vs 56.3%, P <.0001). This difference was mainly due to a reduction in mortality (5.4% vs 21.8%, P = .0012) and infection recurrence (14% vs 35.6%, P = .0007). Patients who presented with severe and complicated disease received guideline-based therapy significantly less often than patients with mild disease (19.7%, 35.3%, and 81.2%, respectively, P <.0001).
  
  
  CONCLUSIONS
  There was a significant reduction in C difficile infection recurrence and mortality when prescribers followed the IDSA/Society for Healthcare Epidemiology of America guidelines for treatment of C difficile infection.
authors.affiliation: Texas Tech University Health Sciences Center School of Pharmacy, Lubbock.
authors.forename: Adam T
authors.initials: AT
authors.lastname: Brown
authors.affiliation: Texas Tech University Health Sciences Center School of Pharmacy, Lubbock. Electronic address: charles.seifert@ttuhsc.edu.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Seifert
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D003967:Diarrhea / Q000382:microbiology; D004334:Drug Administration Schedule; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008532:Megacolon, Toxic / Q000382:microbiology; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D013781:Texas; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile; Infectious diarrhea; Treatment guidelines