Pediatric Hematology, Oncology, and Stem Cell Transplant Nurse Practitioner, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Women, Family, and Children Nursing, Rush University, Chicago, IL, USA.
J Pediatr Hematol Oncol Nurs. 2023 May-Jun;40(3):188-194. doi: 10.1177/27527530221140063. Epub 2023 Jan 23.
() is the primary cause of healthcare-associated infectious diarrhea. Pediatric patients with oncology and stem cell transplant (SCT) diagnoses are at greater risk of infections (CDI) and colonization than those without. Misdiagnosis of colonization as infection and subsequent unnecessary treatment can lead to antibiotic resistance, increased healthcare costs, and an overestimation of CDI rates. A best practice advisory (BPA) was built into the electronic medical record to guide decision making regarding clinically indicated testing. Tests for CDI were to be sent only if the patient met all the predefined clinical criteria for testing. The number of CDI tests ordered per 1,000 patient days, the number of tests positive per 1,000 patient days, and the proportion of positive tests were compared before and after implementation. The number of tests ordered per 1,000 patient days declined from 8.2 to 5.7 after the intervention. Positive tests per 1,000 patient days increased from 2.2 to 3.5 after the intervention. This demonstrates an increase in the proportion of positive tests from 27% to 61%. This intervention led to fewer CDI tests ordered, but CDI incidence and test positivity proportion increased. This is likely reflective of better-targeted testing for CDI and the identification of true-positive cases of infection, but we cannot rule out a coincident increase in CDI activity during the study period. Through education and electronic reminders of the clinical indicators for testing for CDI, the frequency of testing for was reduced.
（）是导致医源性感染性腹泻的主要原因。与未患有肿瘤和干细胞移植（SCT）诊断的儿科患者相比，患有这些疾病的患者更易发生艰难梭菌感染（CDI）和定植。将定植误诊为感染并进行不必要的治疗可能导致抗生素耐药性增加、医疗保健费用增加以及 CDI 发生率的高估。已将最佳实践咨询（BPA）构建到电子病历中，以指导有关临床指示性检测的决策。只有当患者符合所有预定义的检测临床标准时，才应进行 CDI 检测。在实施前后，比较了每千名患者天的 CDI 检测数量、每千名患者天的阳性检测数量和阳性检测的比例。在干预后，每千名患者天的检测数量从 8.2 降至 5.7。干预后每千名患者天的阳性检测数量从 2.2 增加到 3.5。这表明阳性检测的比例从 27%增加到 61%。该干预措施导致 CDI 检测数量减少，但 CDI 发病率和阳性检测比例增加。这可能反映了针对 CDI 的更有针对性的检测以及感染的真正阳性病例的识别，但我们不能排除研究期间 CDI 活动的巧合增加。通过对 CDI 检测的临床指标进行教育和电子提醒，减少了对检测的频率。
