Lin Michael Y, Stein Brian D, Kothadia Sonya M, Blank Samantha, Schoeny Michael E, Tomich Alexander, Hayden Mary K, Segreti John
Departments of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Nursing, Rush University Medical Center, Chicago, Illinois, USA.
Clin Infect Dis. 2023 Aug 14;77(3):346-350. doi: 10.1093/cid/ciad250.
Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear.
At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates.
During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0-6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P = .14) but did differ between the baseline 2 period and intervention period (P < .001).
An ID-led C. difficile testing approval process was feasible and was associated with a >50% decrease in HO-CDI rates, due to enforcement of appropriate testing.
在医院环境中，艰难梭菌检测不当的情况很常见，当使用单步核酸扩增检测时，可能导致感染的过度诊断。传染病（ID）专家在加强艰难梭菌检测的合理性方面的潜在作用尚不清楚。
在一家拥有697张床位的学术医院，我们进行了一项回顾性研究，时间跨度为2012年3月1日至2019年12月31日，比较了连续3个时间段的医院获得性艰难梭菌感染（HO-CDI）率：基线1期（37个月，无决策支持）、基线2期（32个月，计算机决策支持）和干预期（25个月，对住院第4天或之后的所有艰难梭菌检测强制要求ID专家批准）。我们使用间断增长模型来评估干预措施对HO-CDI率的影响。
在研究期间，我们评估了331180例住院患者和1172015个患者日的艰难梭菌感染情况。在干预期，每天观察到的HO-CDI检测批准请求中位数为1次（范围为0 - 6次警报/天）；提供者获得批准的依从率为85%。每个连续时间段每10000个患者日的HO-CDI率分别为10.2、10.4和4.3例。在调整分析中，两个基线期之间的HO-CDI率无显著差异（P = 0.14），但基线2期和干预期之间存在显著差异（P < 0.001）。
由ID主导的艰难梭菌检测批准流程是可行的，并且由于实施了适当的检测，HO-CDI率降低了50%以上。
