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Effect of Treatment Variation on Outcomes in Patients with Clostridium difficile.
Am J Med. 2014 May 23;
Authors: Brown AT, Seifert CF
Abstract
PURPOSE: 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 versus 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 ICD-9 codes, and included if they were greater than or equal to 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<0.0001). This difference was mainly due to a reduction in mortality (5.4% vs. 21.8%, p=0.0012) and infection recurrence (14% vs. 35.6%, p=0.0007). 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<0.0001).
CONCLUSIONS: There was a significant reduction in C. difficile infection recurrence and mortality when prescribers followed the IDSA/SHEA guidelines for treatment of C. difficile infection.
PMID: 24862310 [PubMed - as supplied by publisher]