Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients.
2-step testing
Admission screening
Antimicrobial stewardship
Clostridium difficile
Diagnosis
Diarrhea
Journal
American journal of infection control
ISSN: 1527-3296
Titre abrégé: Am J Infect Control
Pays: United States
ID NLM: 8004854
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
25
05
2022
revised:
23
08
2022
accepted:
24
08
2022
medline:
23
5
2023
pubmed:
9
9
2022
entrez:
8
9
2022
Statut:
ppublish
Résumé
Effective approaches to reduce Clostridioides difficile infections (CDI) in hospitalized patients are needed. We report data from 3 years preceding and 3 years following interventions that proved successful, with detailed analysis of all cases the first year after implementation. Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the last 24 hours, and a 2-step testing algorithm with samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexing to an enzyme immunoassay (EIA) for the toxin antigen. Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P < .001), while the ratio of observed-to-expected hospital-onset cases diminished to ∼0.50 (P < .02). In the first year, 395 samples were PCR(+), but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples were from hospital day 1 or 2 and classified as present on admission. The mean time from stool collection to report of PCR results was ∼7.5 hours, and the EIA took on average only 68 additional minutes to be reported. The number of incident CDI cases can be dramatically decreased by implementing an admission screening question and a 2-step testing algorithm.
Sections du résumé
BACKGROUND
Effective approaches to reduce Clostridioides difficile infections (CDI) in hospitalized patients are needed. We report data from 3 years preceding and 3 years following interventions that proved successful, with detailed analysis of all cases the first year after implementation.
METHODS
Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the last 24 hours, and a 2-step testing algorithm with samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexing to an enzyme immunoassay (EIA) for the toxin antigen.
RESULTS
Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P < .001), while the ratio of observed-to-expected hospital-onset cases diminished to ∼0.50 (P < .02). In the first year, 395 samples were PCR(+), but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples were from hospital day 1 or 2 and classified as present on admission. The mean time from stool collection to report of PCR results was ∼7.5 hours, and the EIA took on average only 68 additional minutes to be reported.
CONCLUSIONS
The number of incident CDI cases can be dramatically decreased by implementing an admission screening question and a 2-step testing algorithm.
Identifiants
pubmed: 36075295
pii: S0196-6553(22)00662-9
doi: 10.1016/j.ajic.2022.08.027
pii:
doi:
Substances chimiques
Bacterial Toxins
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
668-674Informations de copyright
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.