Patients with Clostridioides difficile infection (CDI) in a hospital setting who had access to an infectious disease specialist (IDS) saw less hospital admission for recurrence and less emergency department visits compared to a hospital setting that did not have an ID provider following them.
The findings were published in Open Forum Infectious Diseases.
The investigators compared C diff treatment amongst 2 hospitals with hospital A having an infectious disease specialist available for patients, and hospital B did not. “The 12-week recurrence rate for treated patients was similar between the hospitals. Nonetheless, only 35.9% of patients with recurrent CDI treated at hospital A required hospital admission, as opposed to 70.6% at hospital B (P = .017). In addition, the proportion of patients who presented to the emergency department for CDI-related problems within 12 weeks of diagnosis was greater in hospital B (35.4% vs 17.2%, P = .016),” the investigators wrote.
There were additional clinical benefits associated with care utilizing an ID provider. “Hospital A avoided more unnecessary treatments (19.3% vs 11.5%), provided access to novel therapies more frequently (35.3% vs 13%), and adhered more closely to current guidelines (95.8% vs 71.3%).”
What You Need to Know
Patients with CDI who had access to an IDS had fewer hospital admissions for recurrence (35.9% vs. 70.6%, P = .017) and fewer CDI-related emergency department visits (17.2% vs. 35.4%, P = .016) compared to those without IDS involvement.
The IDS-involved hospital (Hospital A) avoided more unnecessary treatments (19.3% vs. 11.5%), had better access to novel therapies (35.3% vs. 13%), and adhered more closely to current guidelines (95.8% vs. 71.3%) than the hospital without IDS support (Hospital B).
The study highlighted that IDS oversight led to better clinical outcomes, with fewer patients receiving unnecessary antibiotics, and more efficient utilization of hospital resources.
Study Design and Takeaways
The investigators performed a retrospective cohort study of patients with positive test results for toxigenic C difficile in 2 hospitals (hospitals A and B) in a similar region in Spain from January 2021 through December 2021.
Hospital A was a 900-bed university referral hospital that offered transplant, cardiac, and neurosurgery services. And hospital B was a teaching hospital with lower complexity and only 380 beds.
In terms of testing, hospital A used, “a 3-step algorithm based on glutamate dehydrogenase (GDH) as a screening method was employed for diagnosis. When GDH is positive, the toxin is determined, and if the toxin is negative, the discrepancy is resolved by nucleic acid amplification test (NAAT). The diagnosis in hospital B was determined by a positive NAAT result. All positive results are confirmed by toxigenic culture in both hospitals. Neither hospital´s microbiology reports suggest the interpretation of polymerase chain reaction as colonization.”
For hospital A, the investigators set up 2 parts of their intervention to support patients: (1) assessment and advice from an infectious disease specialist for each patient with a positive test. The IDS would determine whether treatment was needed and if so, what medications; (2) and accessibility and continuity of care with an IDS in which patients could receive written and verbal information.
Hospital B did not have a C diff treatment program. Laboratory results were uploaded to the electronic medical record, and patients were treated by their responsible physicians not matter the providers speciality. And no infectious disease providers were available at hospital B.
“As with other serious infectious diseases, oversight and management by an IDS may result in better outcomes and resource utilization,” the investigators wrote. “However, there are almost no studies evaluating the clinical outcomes of a program for CDI managed by an IDS. In this study, we observed a greater proportion of patients who did not receive antibiotics because they were evaluated as colonized, as well as better adherence to clinical guidelines, easier access to novel therapies, and a decrease in hospital resource utilization.”
Reference
Sara Kamel, María Dolores Corbacho-Loarte, Rosa Escudero-Sánchez, Ana Halperin, Sergio Llorente, Sara María Quevedo, Cecilia Suárez-Carantoña, Laura del Campo, María Soledad Hernández, Santiago Moreno Guillen, Javier Cobo, Impact of an Intervention Program on Clostridioides difficile Infections: Comparison of 2 Hospital Cohorts, Open Forum Infectious Diseases, Volume 11, Issue 7, July 2024, ofae390, https://doi.org/10.1093/ofid/ofae390
