Removing C. difficile from GI pathogen panels reduces unnecessary treatment
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Key takeaways:
- Removing C. difficile from GI pathogen panels increased use of preferred testing and decreased unnecessary treatment.
- This did not result in an increase in delayed diagnoses.
Researchers found that removing Clostridioides difficile from gastrointestinal pathogen panels reduced unnecessary treatment without causing delays in diagnosis.
“The idea behind looking at the [gastrointestinal (GI) pathogen] panel as a source of inappropriate testing and treatment came to me during my usual work as an antimicrobial stewardship pharmacist,” Dan Ilges, PharmD, antimicrobial stewardship pharmacist at Mayo Clinic in Arizona, told Healio.
“Our electronic medical record generates a list of patients to review for certain indications, including positive C. difficile test results. I started noticing the GI pathogen panel taking over as the ‘preferred’ and possibly only test that providers were using for infectious diarrhea/C. difficile,” he said.
Many studies have shown the C. difficile target is the most frequent positive target, however, some of the patients that were positive and were receiving treatment “didn’t seem like usual C. difficile cases” and “seemed like possible colonization,” Ilges said.
“Once we started digging into the issue, we discovered that the manufacturer had released a new software package to suppress the C. difficile results completely,” he said. “With this intervention and survey data suggesting that the panel was being misused to diagnose C. difficile, we went ahead with removing but made concerted efforts to ensure that providers were aware of this change at every step (eg ordering and resulting).”
To assess how this would impact testing rates and treatment prescriptions, Ilges and colleagues at the Mayo Clinic Arizona conducted a retrospective cohort study of adult patients who received C. difficile testing or treatment between Jan. 1, 2022, and Jan. 31, 2024.
The researchers initially used a GI pathogen panel (GIPP) containing 22 targets including C. difficile during the baseline period but had it removed as a target during the postintervention period.
At baseline, 2,772 GIPPs were completed for 2,307 patients between Jan. 1, 2022, and Jan. 31, 2023. The most common positive target was C. difficile (51%), resulting in treatment in 94.9% cases. During the postintervention period, which took place from March 1, 2023, to Jan. 31, 2024, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (P < .001).
Data also showed that C. difficile treatment prescriptions decreased in both inpatient and outpatient settings in the postintervention period. Outpatient prescriptions decreased from 2.36 per 1,000 outpatient visits in the baseline period to 1.81 per 1,000 outpatient visits in the postintervention period (P = .001), while inpatient prescriptions decreased from 13.77 per 1,000 visits during the baseline period to 10.58 in the postintervention period.
Study data also showed that removing C. difficile as a target of the panel did not cause delays in patient care. Specifically, data showed that among 36 patient records with C. difficile detected more than 72 hours after admission, none had delayed testing or diagnosis during the postintervention period.
“Clinical decision support and diagnostic stewardship of GI pathogen panel results can optimize preferred testing,” Ilges concluded. “Results are best when stakeholders are included in the process.”
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