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Two-step C. difficile Testing Algorithm Reduces Antibiotic Use
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A two-step testing algorithm for detection of Clostridium difficile infection was associated with a significant decrease in use of anti-CDI antibiotics, according to research presented at the Society of Hospital Medicine Annual Meeting.
In June 2013, the research team’s laboratory transitioned from an enzyme immunoassay test for C. difficile toxins A and B to a two-step testing algorithm incorporating a glutamate dehydrogenase antigen assay. To compare the management of suspected CDI before and after this transition, the researchers performed a retrospective chart review of patients hospitalized at Mount Sinai St. Luke’s and Mount Sinai West Hospitals who were tested for CDI before (Group 1; n = 268; 53% women; mean age, 65.5 years) and after (Group 2; n = 255; 51% women; mean age, 63.6 years) the two-step algorithm was implemented.
“The most notable finding was a decreased duration of anti-CDI therapy for patients in Group 2,” which was significant for both CDI-positive (P = .005) and -negative (P < .001) patients who received empiric treatment, the researchers wrote. The use of isolation measures such as contact precautions and isolation days was reduced in CDI-negative patients in Group 2 (2.83 vs. 2.56 days), but this was not statistically significant.
“Our results suggest that the increased sensitivity and specificity of the two-step testing protocol allows clinicians to limit unnecessary empiric treatment and thereby reduce the risk of emerging resistance and other adverse effects by minimizing the patient’s exposure,” the researchers concluded. Changing the diagnostic approach “has far reaching implications for the overall care for CDI [and] it remains to be proven if outcome measures such as length of stay, recurrence, mortality and morbidity will also be affected,” they added. – by Adam Leitenberger
Referen ce:
Abed J, et al. Abstract 192. Presented at: SHM Annual Meeting; March 6-9, 2016; San Diego.
Disclosure: Healio Gastroenterology was unable to confirm relevant financial disclosures at the time of publication.