Evaluation of aClostridium difficileinfection management policy with clinical pharmacy and medical microbiology involvement at a major Canadian teaching hospital

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Abstract

What is known and objective:

Clostridium difficileinfection (CDI) represents a spectrum of disease and is a significant concern for healthcare institutions. Our study objective was to assess whether implementation of a regional CDI management policy with Clinical Pharmacy and Medical Microbiology and Infection Control involvement would lead to an improvement in concordance in prescribing practices to an evidence-based CDI disease severity assessment and pharmacological treatment algorithm.

Methods:

Conducted at a tertiary care teaching hospital, this two-phase quality assurance study consisted of a baseline retrospective healthcare record review of patients with CDI prior to the implementation of a regional CDI management policy followed by a prospective evaluation post-implementation.

Results and discussion:

One hundred and forty-one CDI episodes in the pre-implementation group were compared to 283 episodes post-implementation. Overall treatment concordance to the CDI treatment algorithm was achieved in 48 of 141 cases (34%) pre-implementation compared with 136 of 283 cases (48·1%) post-implementation (P= 0·01). The median time to treatment with vancomycin was reduced from five days to one day (P< 0·01), with median length of hospital stay decreasing from 30 days to 21 days (P= 0·01) post-implementation. There was no difference in 30-day all-cause mortality.

What is new and conclusion:

A comprehensive approach with appropriate stakeholder involvement in the development of clinical pathways, education to healthcare workers and prospective audit with intervention and feedback can ensure patients diagnosed with CDI are optimally managed and prescribed the most appropriate therapy based on CDI disease severity.

The implementation of a Clostridium difficile infection (CDI) management policy with clinical pharmacy and medical microbiology involvement is an effective antimicrobial stewardship strategy to change prescribing and ensure appropriate CDI treatment. By having clinical pharmacists follow-up on all CDI patients, all CDI therapies are assessed and interventions are made when treatments need to be optimized, as required. Through this initiative, CDI treatment has improved, and a reduction in time to initiation of vancomycin and hospital length of stay have been observed.

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