Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study

Ali Elbeddini

doi:doi:10.11648/j.ijidt.20180303.12

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Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study

Ali Elbeddini

Published in International Journal of Infectious Diseases and Therapy (Volume 3, Issue 3)

Received: 14 September 2018 Accepted: 9 October 2018 Published: 23 October 2018

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Abstract

Clostridium difficile infection (CDI) is responsible for 15 – 25% cases of health-care associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval and duration indicated based on the disease severity and episode within 24 hours of diagnosis. In addition, our study also described the population and their risk factors for CDI at our hospital. This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st 2017 to June 30th 2018. Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild to moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months. The use of a PPI in this study, a modifiable risk factor without a clear indication was 35%. The conclusion was that there is an area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.

Published in	International Journal of Infectious Diseases and Therapy (Volume 3, Issue 3)
DOI	10.11648/j.ijidt.20180303.12
Page(s)	52-61
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Clostridium Difficile Infection, Adherence, Infectious Diseases Society of America 2010 C. Difficile Guideline

References

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[2]	Public Health Ontario: Monthly Infectious Disease Surveillance Report. Volume 4, Issue 8, Aug 2015.
[3]	Debast, SB. Bauer, MP, Kuijper EJ. European Society of Clinical Microbiology and Infectious Diseases: update of the treatment guidance document for Clostridium difficile infection. Clin Microbiol Infect 2014, 20 (Suppl. 2), 1–26.
[4]	Fekety, R., Elmer, G., Greenberg, R., McFarland, L., Mulligan, M., Surawicz, C. Recurrent Clostridium difficile Diarrhea: Characteristics of and Risk Factors for Patients Enrolled in a Prospective, Randomized, Double-Blinded Trial. Clinical Infectious Diseases 1997; 24:324–33.
[5]	Owens, R., Donskey C., Gaynes, R., Loo, V., Muto, C. Antibiotic-Associated Risk Factors for Clostridium difficile Infection. Clinical Infectious Diseases 2008; 46:S19-31.
[6]	Janarthanan, S., Ditah, I., Douglas, G., M Phil, Murrary, E. Clostridium difficile -Associated Diarrhea and Proton Pump Inhibitor Therapy: A Meta-Analysis. Am J Gastroenterol 2012; 107:1001–1010.
[7]	Prévention des Infections. Infection a Clostridium difficile (ICD): Politiques et procedures de Montfort. Fevrier 2016.
[8]	Kao, D. Diarrhea. Therapeutics Choices, June 2014.
[9]	Pépin J, Valiquette L, Alary ME, Villemure P, Pelletier A, Forget K, Pépin K, Chouinard DClostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004; 171(5):466.
[10]	Vaillancourt, L., Do, K., Shymanski, K, Landry, C. Traitement de l’infection à l’infection clostridium difficile. La capsule Montfort. April 2016.
[11]	Surawicz, CM. Brandt, LJ., Binion, DG. Et al. Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections. Am J Gastroenterol 2013; 108:478–498.
[12]	Health Quality Ontario. Public Reporting. http://www.hqontario.ca/Public-Reporting/Patient- Safety/About-Patient-Safety-Public-ReportingTesting, Surveillance and Management of Clostridium difficile In All Health Care Settings: http://www.publichealthontario.ca/en/eRepository/PIDACIPC_Annex_C_Testing_SurveillanceManage_C_difficile_2013.pdf
[13]	Kelly, CP., Lamont, JT. Clostridium difficile in adults: Treatment. Up-to-date [Internet]. 2017 April [cited 2017 May 14]. Available from: Http: //www.uptodate.com/contents/clostridiumdifficile-in-adults-treatment?source=search_result&search=c+difficile&selectedTitle=1~150
[14]	Gut Sense: Bristol Stool Form Scale: www.gutsense.org356 × 448Search by image. Retrieved on Aug 1, 2017
[15]	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) [published online February 15, 2018]. Clin Infect Dis. doi: 10.1093/cid/cix1085

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APA Style

Ali Elbeddini. (2018). Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. International Journal of Infectious Diseases and Therapy, 3(3), 52-61. https://doi.org/10.11648/j.ijidt.20180303.12

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Ali Elbeddini. Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. Int. J. Infect. Dis. Ther. 2018, 3(3), 52-61. doi: 10.11648/j.ijidt.20180303.12

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AMA Style

Ali Elbeddini. Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. Int J Infect Dis Ther. 2018;3(3):52-61. doi: 10.11648/j.ijidt.20180303.12

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@article{10.11648/j.ijidt.20180303.12,
  author = {Ali Elbeddini},
  title = {Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {3},
  number = {3},
  pages = {52-61},
  doi = {10.11648/j.ijidt.20180303.12},
  url = {https://doi.org/10.11648/j.ijidt.20180303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20180303.12},
  abstract = {Clostridium difficile infection (CDI) is responsible for 15 – 25% cases of health-care associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval and duration indicated based on the disease severity and episode within 24 hours of diagnosis. In addition, our study also described the population and their risk factors for CDI at our hospital. This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st 2017 to June 30th 2018. Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild to moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months. The use of a PPI in this study, a modifiable risk factor without a clear indication was 35%. The conclusion was that there is an area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.},
 year = {2018}
}

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TY - JOUR
T1 - Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study
AU - Ali Elbeddini
Y1 - 2018/10/23
PY - 2018
N1 - https://doi.org/10.11648/j.ijidt.20180303.12
DO - 10.11648/j.ijidt.20180303.12
T2 - International Journal of Infectious Diseases and Therapy
JF - International Journal of Infectious Diseases and Therapy
JO - International Journal of Infectious Diseases and Therapy
SP - 52
EP - 61
PB - Science Publishing Group
SN - 2578-966X
UR - https://doi.org/10.11648/j.ijidt.20180303.12
AB - Clostridium difficile infection (CDI) is responsible for 15 – 25% cases of health-care associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval and duration indicated based on the disease severity and episode within 24 hours of diagnosis. In addition, our study also described the population and their risk factors for CDI at our hospital. This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st 2017 to June 30th 2018. Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild to moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months. The use of a PPI in this study, a modifiable risk factor without a clear indication was 35%. The conclusion was that there is an area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.
VL - 3
IS - 3
ER -

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Author Information

Ali Elbeddini

Department of Clinical Pharmacy, Winchester District Memorial Hospital WDMH, Winchester, Canada

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APA Style

Ali Elbeddini. (2018). Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. International Journal of Infectious Diseases and Therapy, 3(3), 52-61. https://doi.org/10.11648/j.ijidt.20180303.12

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ACS Style

Ali Elbeddini. Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. Int. J. Infect. Dis. Ther. 2018, 3(3), 52-61. doi: 10.11648/j.ijidt.20180303.12

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AMA Style

Ali Elbeddini. Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study. Int J Infect Dis Ther. 2018;3(3):52-61. doi: 10.11648/j.ijidt.20180303.12

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@article{10.11648/j.ijidt.20180303.12,
  author = {Ali Elbeddini},
  title = {Treatment of Clostridium Difficile Infection in Community Teaching Hospital: A Retrospective Study},
  journal = {International Journal of Infectious Diseases and Therapy},
  volume = {3},
  number = {3},
  pages = {52-61},
  doi = {10.11648/j.ijidt.20180303.12},
  url = {https://doi.org/10.11648/j.ijidt.20180303.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20180303.12},
  abstract = {Clostridium difficile infection (CDI) is responsible for 15 – 25% cases of health-care associated diarrhea. The CDI treatment algorithm used at our hospital is adapted from the Infectious Diseases Society of America 2010 C. difficile guideline. The primary objective of this study was to assess the treatment adherence to our algorithm; this was defined as therapy consisting of the appropriate antibiotic, dose, route, interval and duration indicated based on the disease severity and episode within 24 hours of diagnosis. In addition, our study also described the population and their risk factors for CDI at our hospital. This was a single-centre, retrospective cohort chart review of CDI cases that were diagnosed at admission or during hospitalization from June 1st 2017 to June 30th 2018. Sixty cases were included, of which adherence to our algorithm was 50%. Overall, severe CDI had the highest treatment non-adherence (83%) and the biggest contributing factor was prescribing the wrong antibiotic (72%). In severe CDI, which warrants vancomycin monotherapy, wrong antibiotic consisted of metronidazole monotherapy (55%) or dual therapy with metronidazole and vancomycin (45%). Patients were mostly older, females being treated for an initial episode of mild to moderate CDI. Common risk factors identified were age over 65 years (80%), use of antibiotics (83%) and proton pump inhibitors (PPI) (68%) within the previous three months. The use of a PPI in this study, a modifiable risk factor without a clear indication was 35%. The conclusion was that there is an area for antimicrobial stewardship intervention in CDI treatment at our hospital is prescribing the right antibiotic based on the CDI indication. In severe CDI, an emphasis should be on prescribing vancomycin monotherapy as the drug of choice. PPI use should be reassessed for tapering when appropriate.},
 year = {2018}
}

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