Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics. (15th February 2023)

• Record Type: Journal Article
• Authors: Halabi, Katia C.; Ross, Barbara; Acker, Karen P.; Cannon, Jean-Marie; Messina, Maria; Mangino, Diane; Balzer, Krystal; Hill-Ricciuti, Alexandra; Green, Daniel A.; Westblade, Lars F.; Salvatore, Christine M.; Saiman, Lisa
• Is Part Of: Infection control and hospital epidemiology. Volume 44:Number 2(2023)
• Page Start: 186
• Page End: 190
• Publication Date: 2023-02-15
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2022.117
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract: Objective: To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs). Design: We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017–October 2018) and after (November 2018–October 2020) implementing restrictive computerized provider order entry (CPOE). Setting: Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution. Methods: In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13–23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis. Results: An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups ( P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13–23 months ( P < .001) and all ages combined ( P = .003). Conclusion: Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.