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Erschienen in: Journal of General Internal Medicine 2/2020

25.11.2019 | Original Research

Treatment of Clostridioides difficile Infection and Non-compliance with Treatment Guidelines in Adults in 10 US Geographical Locations, 2013–2015

verfasst von: Shannon A. Novosad, MD, MPH, Yi Mu, PhD, Lisa G. Winston, MD, Helen Johnston, MPH, Elizabeth Basiliere, AAS, Danyel M. Olson, MS, MPH, Monica M. Farley, MD, Andrew Revis, MPH, Lucy Wilson, MD, ScM, Rebecca Perlmutter, MPH, Stacy M. Holzbauer, DVM, MPH, Tory Whitten, MPH, Erin C. Phipps, DVM, MPH, Ghinwa K. Dumyati, MD, Zintars G. Beldavs, MS, Valerie L. S. Ocampo, RN, MIPH, Corinne M. Davis, MPH, MS, Marion Kainer, MBBS, MPH, Dale N. Gerding, MD, Alice Y. Guh, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 2/2020

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Abstract

Background

Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) guidelines describe recommended therapy for Clostridioides difficile infection (CDI).

Objective

To describe CDI treatment and, among those with severe CDI, determine predictors of adherence to the 2010 IDSA/SHEA treatment guidelines.

Design

We analyzed 2013–2015 CDI treatment data collected through the Centers for Disease Control and Prevention’s Emerging Infections Program. Generalized linear mixed models were used to identify predictors of guideline-adherent therapy.

Patients

A CDI case was defined as a positive stool specimen in a person aged ≥ 18 years without a positive test in the prior 8 weeks; severe CDI cases were defined as having a white blood cell count ≥ 15,000 cells/μl.

Main Measures

Prescribing and predictors of guideline-adherent CDI therapy for severe disease.

Key Results

Of 18,243 cases, 14,257 (78%) were treated with metronidazole, 7683 (42%) with vancomycin, and 313 (2%) with fidaxomicin. The median duration of therapy was 14 (interquartile range, 11–15) days. Severe CDI was identified in 3250 (18%) cases; of 3121 with treatment data available, 1480 (47%) were prescribed guideline-adherent therapy. Among severe CDI cases, hospital admission (adjusted odds ratio [aOR] 2.48; 95% confidence interval [CI] 1.90, 3.24), age ≥ 65 years (aOR 1.37; 95% CI 1.10, 1.71), Charlson comorbidity index ≥ 3 (aOR 1.27; 95% CI 1.04, 1.55), immunosuppressive therapy (aOR 1.21; 95% CI 1.02, 1.42), and inflammatory bowel disease (aOR 1.56; 95% CI 1.13, 2.17) were associated with being prescribed guideline-adherent therapy.

Conclusions

Provider adherence to the 2010 treatment guidelines for severe CDI was low. Although the updated 2017 CDI guidelines, which expand the use of oral vancomycin for all CDI, might improve adherence by removing the need to apply severity criteria, other efforts to improve adherence are likely needed, including educating providers and addressing barriers to prescribing guideline-adherent therapy, particularly in outpatient settings.
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Metadaten
Titel
Treatment of Clostridioides difficile Infection and Non-compliance with Treatment Guidelines in Adults in 10 US Geographical Locations, 2013–2015
verfasst von
Shannon A. Novosad, MD, MPH
Yi Mu, PhD
Lisa G. Winston, MD
Helen Johnston, MPH
Elizabeth Basiliere, AAS
Danyel M. Olson, MS, MPH
Monica M. Farley, MD
Andrew Revis, MPH
Lucy Wilson, MD, ScM
Rebecca Perlmutter, MPH
Stacy M. Holzbauer, DVM, MPH
Tory Whitten, MPH
Erin C. Phipps, DVM, MPH
Ghinwa K. Dumyati, MD
Zintars G. Beldavs, MS
Valerie L. S. Ocampo, RN, MIPH
Corinne M. Davis, MPH, MS
Marion Kainer, MBBS, MPH
Dale N. Gerding, MD
Alice Y. Guh, MD, MPH
Publikationsdatum
25.11.2019
Verlag
Springer US
Erschienen in
Journal of General Internal Medicine / Ausgabe 2/2020
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-019-05386-9

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