title: [Identifying gaps between guidelines and clinical practice in Clostridium difficile infection].
abstract: OBJECTIVE
  The first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation.
  
  
  METHODS
  A retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined
  
  
  RESULTS
  A total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (P<.003). Adherence was significantly associated with clinical cure (57% vs 42%), fewer recurrences (22.2% vs 77.7%), and mortality (25% vs 75%) (P<.01). The stratification of severity of the episode, and the adequacy of antibiotic to clinical severity, need improvement.
  
  
  CONCLUSIONS
  Overall adherence with the guidelines for management of Clostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted.
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: C
authors.initials: C
authors.lastname: Rodríguez-Martín
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: A
authors.initials: A
authors.lastname: Serrano-Morte
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España. Electronic address: lsanchezmunoz@gmail.com.
authors.forename: L A
authors.initials: LA
authors.lastname: Sánchez-Muñoz
authors.affiliation: Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: P A
authors.initials: PA
authors.lastname: de Santos-Castro
authors.affiliation: Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Bratos-Pérez
authors.affiliation: Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
authors.forename: R
authors.initials: R
authors.lastname: Ortiz de Lejarazu-Leonardo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy*; D019983:Guideline Adherence; D006801:Humans; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adherence; Adherencia; Antimicrobial use; Clostridium difficile infection; Guidelines; Guías de práctica clínica; Infección por Clostridium difficile; Utilización de antimicrobianos