title: Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates.
abstract: Health care-onset health care facility-associatedClostridium difficileinfection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence ofC. difficilecolonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients withC. difficiletest orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures includedC. difficiletest utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321C. difficiletest orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively.C. difficiletest utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P< 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P= 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P= 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negativeC. difficileresults. Real-time electronic clinical data tracking is an effective tool for verification ofC. difficileclinical testing criteria and safe reduction of inflated HO-CDI rates.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Cynthia Y
authors.initials: CY
authors.lastname: Truong
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Gombar
authors.affiliation: Digital Solutions, Stanford Health Care, Stanford, California, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Wilson
authors.affiliation: Digital Solutions, Stanford Health Care, Stanford, California, USA.
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Sundararajan
authors.affiliation: Digital Solutions, Stanford Health Care, Stanford, California, USA.
authors.forename: Natasa
authors.initials: N
authors.lastname: Tekic
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.|Infection Control and Prevention, Stanford Health Care, Stanford, California, USA.|Stanford Antimicrobial Safety and Sustainability, Stanford Health Care, Stanford, California, USA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Holubar
authors.affiliation: Infection Control and Prevention, Stanford Health Care, Stanford, California, USA.
authors.forename: John
authors.initials: J
authors.lastname: Shepard
authors.affiliation: Infection Control and Prevention, Stanford Health Care, Stanford, California, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Madison
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.|Infection Control and Prevention, Stanford Health Care, Stanford, California, USA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Tompkins
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.|Stanford Antimicrobial Safety and Sustainability, Stanford Health Care, Stanford, California, USA.
authors.forename: Stan
authors.initials: S
authors.lastname: Deresinski
authors.affiliation: Department of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
authors.forename: Lee F
authors.initials: LF
authors.lastname: Schroeder
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, USA nbanaei@stanford.edu.|Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.|Clinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA.
authors.forename: Niaz
authors.initials: N
authors.lastname: Banaei
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects; D003428:Cross Infection / Q000453:epidemiology*; D003967:Diarrhea / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D001330:Electronic Data Processing / Q000379:methods*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006751:Hospital Information Systems; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D054368:Laxatives; D008795:Metronidazole; D014640:Vancomycin
keywords: Clostridium difficile; data tracking; evidence-based medicine; verification