Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-13T04:32:01.615Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of Connecticut medical providers’ concordance with 2017 IDSA/SHEA Clostridioides difficile treatment guidelines in New Haven County, 2018–2019

Published online by Cambridge University Press:  25 November 2020

Casey Morgan Luc Open the ORCID record for Casey Morgan Luc [Opens in a new window] ,
Danyel Olson ,
David B. Banach ,
Paula Clogher  and
James Hadler
Casey Morgan Luc*
Affiliation:
Yale School of Public Health, New Haven, Connecticut Connecticut Emerging Infections Program, New Haven, Connecticut
Danyel Olson
Affiliation:
Connecticut Emerging Infections Program, New Haven, Connecticut
David B. Banach
Affiliation:
Yale School of Public Health, New Haven, Connecticut University of Connecticut School of Medicine, Farmington, Connecticut
Paula Clogher
Affiliation:
Connecticut Emerging Infections Program, New Haven, Connecticut
James Hadler
Affiliation:
Yale School of Public Health, New Haven, Connecticut Connecticut Emerging Infections Program, New Haven, Connecticut
*
Author for correspondence: Casey Morgan Luc, E-mail: casey.luc@yale.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To assess Connecticut medical providers’ concordance (2018–2019) with the 2017 Clostridioides difficile infection (CDI) treatment update by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA). The effect of guideline concordance on CDI recurrence risk was also assessed.

Design:

Prospective, population-based study.

Setting:

New Haven County, Connecticut, from January 1, 2017, to December 31, 2019.

Patients:

CDI incident case (no positive tests in the prior 8 weeks), not limited by care setting.

Methods:

Using data from the Emerging Infections Program’s CDI surveillance, severity and concordance were defined. Presence of megacolon and/or ileus defined fulminant disease; absence defined nonsevere/severe disease. Using 2017 treatment as baseline, 2018–2019 concordance was defined as receiving the recommended first-line antibiotic (ie, vancomycin or fidaxomicin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. For all analyses, significance was P < .05.

Results:

Among 990 cases, concordance increased from 24.8% in 2018 to 37.0% in 2019. First-line antibiotic concordance increased from 61.2% in 2018 to 79.9% in 2019. Recurrence risk was significantly associated with patients aged ≥65 years and was highest for those aged 75–84 years, but this factor was not significantly associated with concordance.

Conclusions:

From 2018 through 2019, CDI treatment in New Haven County increasingly was concordant with the 2017 treatment update but remained low in 2019. Although concordance with treatment guidelines did not affect recurrence risk, close attention should be paid by medical providers to patients aged ≥65 years, specifically those aged 75–84 years because they are at an increased risk for recurrence.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 5 , May 2021 , pp. 549 - 556
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of healthcare-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle Scholar
Khanna, S, Pardi, DS, Aronson, SL, et al. The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol 2012;107:89–95.CrossRefGoogle ScholarPubMed
Guh, AY, Mu, Y, Winston, LG, et al. Trends in US burden of Clostridioides difficile infection and outcomes. N Engl J Med 2020;382:1320–1330.CrossRefGoogle Scholar
Johnson, S, Louie, TJ, Gerding, DN, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis 2014;59:345–354.CrossRefGoogle ScholarPubMed
Wilcox, MH, Rooney, CM. Comparison of the 2010 and 2017 Infectious Diseases Society of America guidelines on the diagnosis and treatment of Clostridium difficile infection. Curr Opin Gastroenterol 2019;35:20–24.CrossRefGoogle Scholar
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Bariola, JR, Khaden, T. 1987. Impact of updated IDSA Clostridium difficile guidelines on the use of fidaxomicin in a large health system. Open Forum Infect Dis 2019;6:S666.CrossRefGoogle Scholar
Clancy, CJ, Nguyen, MH. 779. Impact of updated IDSA practice guidelines on the treatment of Clostridium difficile infections in the United States. Open Forum Infect Dis 2019;6:S346.CrossRefGoogle Scholar
Martinez, N, Meek, J, Olson, D, et al. Evaluation of adherence to treatment guidelines among cases of Clostridium difficile infection in New Haven County, Connecticut, 2013–2016. Connecticut Med 2018;8:481–485.Google Scholar
Musher, DM, Aslam, S, Logan, N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clin Infect Dis 2005;40:1586–1590.CrossRefGoogle ScholarPubMed
Doh, YS, Kim, YS, Jung, HJ, et al. Long-term clinical outcome of Clostridium difficile infection in hospitalized patients: a single center study. Intest Res 2014;12:299.CrossRefGoogle ScholarPubMed
Clancy, CJ, Buehrle, D, Vu, M, et al. Impact of revised Infectious Diseases Society of America and Society for Healthcare Epidemiology of America clinical practice guidelines on the treatment of Clostridium difficile infections in the United States. Clin Infect Dis 2020;ciaa484.CrossRefGoogle Scholar
Bunnell, KL, Danziger, LH, Johnson, S. Economic barriers in the treatment of Clostridium difficile infection with oral vancomycin. Open Forum Infect Dis 2017;4:ofx078.CrossRefGoogle Scholar
Stevens, VW, Nelson, RE, Schwab-Daugherty, EM, et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Intern Med 2017;177:546–553.CrossRefGoogle ScholarPubMed
Cornely, OA, Miller, MA, Louie, TJ, et al. Treatment of first recurrence of Clostridium difficile infection: fidaxomicin versus vancomycin. Clin Infect Dis 2012;55 suppl 2:S154–S161.CrossRefGoogle Scholar
Guery, B, Menichetti, F, Anttila, VJ, et al. Extended-pulsed fidaxomicin versus vancomycin for Clostridium difficile infection in patients 60 years and older (EXTEND): a randomised, controlled, open-label, phase 3b/4 trial. Lancet Infect Dis 2018;18:296–307.CrossRefGoogle ScholarPubMed