Department of Infection Prevention and Control, St. Joseph Mercy Health System, Ann Arbor, MI; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
Department of Infection Prevention and Control, St. Joseph Mercy Health System, Ann Arbor, MI; Department of Internal Medicine, Division of Infectious Diseases, St. Joseph Mercy Health System, Ann Arbor, MI.
Am J Infect Control. 2019 Feb;47(2):170-174. doi: 10.1016/j.ajic.2018.08.008. Epub 2018 Oct 6.
It is recommended that that only unformed stool from patients with diarrhea be tested for Clostridium difficile infection. We determined the prevalence of and patient characteristics associated with antecedent laxative receipt among hospitalized adults undergoing C difficile testing.
In a case-control study of 5,452 C difficile tests from 5 hospitals in Southeast Michigan, patients who received laxatives (docusate, senna, polyethylene glycol 3350, bisacodyl, and magnesium hydroxide) in the 24 or 48 hours before testing were identified. Logistic regression was performed to identify patient characteristics associated with laxative receipt before testing.
In 535 (9.8%) and 707 (13%) tests, patients received laxatives in the 24 and 48 hours before testing, respectively. The odds of antecedent laxative receipt were significantly greater for patients residing on a surgical service than a medical service (24 hours odds ratio [OR], 2.5; 95% confidence interval [CI], 2.1-3.1; 48 hours OR, 2.7; 95% CI, 2.3-3.2), patients residing in an intensive care unit (ICU) than a non-ICU (24 hours OR, 1.3; 95% CI, 1.0-1.6; 48 hours OR, 1.3; 95% CI, 1.1-1.6), and patients whose Elixhauser Comorbidity Score was 4 or higher (24 hours OR, 1.4; 95% CI, 1.1-1.7; 48 hours OR, 1.4; 95% CI, 1.2-1.7).
Among patients tested for C difficile, antecedent laxative use was common. Improving diagnostic stewardship around C difficile testing, particularly in surgical and ICU patients, is a significant opportunity and priority for quality improvement.
建议仅对腹泻患者的未成形粪便进行艰难梭菌感染检测。我们确定了在接受艰难梭菌检测的住院成年人中，与接受检测前使用泻药相关的患病率和患者特征。
在密歇根州东南部 5 家医院的 5452 例艰难梭菌检测的病例对照研究中，确定了在检测前 24 或 48 小时内接受过泻药（多库酯、番泻叶、聚乙二醇 3350、比沙可啶和氢氧化镁）的患者。采用 logistic 回归分析确定与检测前接受泻药相关的患者特征。
在 535 例（9.8%）和 707 例（13%）检测中，患者在检测前 24 小时和 48 小时分别接受了泻药。与住在医疗服务病房的患者相比，住在外科病房的患者接受前序泻药的可能性显著更高（24 小时比值比[OR]，2.5；95%置信区间[CI]，2.1-3.1；48 小时 OR，2.7；95% CI，2.3-3.2）；与不住在 ICU 的患者相比，住在 ICU 的患者接受前序泻药的可能性更高（24 小时 OR，1.3；95% CI，1.0-1.6；48 小时 OR，1.3；95% CI，1.1-1.6）；Elixhauser 合并症评分≥4 分的患者接受前序泻药的可能性更高（24 小时 OR，1.4；95% CI，1.1-1.7；48 小时 OR，1.4；95% CI，1.2-1.7）。
在接受艰难梭菌检测的患者中，前序使用泻药很常见。改善艰难梭菌检测的诊断管理，特别是在外科和 ICU 患者中，是一个重大的质量改进机会和优先事项。
