Managing CDI in the Ambulatory Setting

Clostridioides difficile (CDI) management in the inpatient setting has been well-documented, so a team of investigators at Carilion Roanoke Memorial Hospital, Roanoke, Virginia, wanted to see how patients in their ambulatory settings were going through the continuum of care.

A total of 50 patients were included from family/internal medicine (FM/IM), urgent care, gastrointestinal(GI), and pediatric sites.

“Management of CDIs was appropriate at only 18% (9/50) of sites, with the highest percentage of appropriate management occurring at UC sites at 38% (3/8). CDI testing was also not consistent throughout the sites, with 30% (15/30) of the CDI testing using a stool culture with reflex to toxin B PCR,” the investigators wrote. “Treatment of negative CCNA results also occurred in 28% (N=14) of patients, with pediatrics being the only site delaying treatment until CCNA returns.”

In addition, they noted that 64% of patients were treated with oral vancomycin, 18% with metronidazole, and 18% fidaxomicin.

“CDI is not appropriately managed at the majority of ambulatory sites at Carilion, and additional education opportunities exist on the management of CDIs with emphasis on updating diagnostic testing to only allow toxin B PCR with reflex CCNA and utilizing fidaxomicin first-line in treatment,” the study investigators concluded.

The study, “Management of Clostridioides difficile Infections at Ambulatory Practices,”was presentedat the 24th Annual Making a Difference in Infectious Disease (MAD-ID) Meeting 2022,in Orlando, Fl from May 18-21.

Contagion spoke to study coauthor Yang Zhao, PharmD, BCPS at the meeting who provided insights on the study, and the adoption of fidaxomicin in the clinical setting.