5 factors associated with nonadherence to CDI treatment guidelines
Less than half of patients in this study have met the criteria for severe Clostridium difficile infection (CDI). Furthermore, almost half of providers for those with severe infection and longer duration of antibiotic therapy are less likely to adhere to the institutional guideline.
There were 387 patients (42.4 percent) who met the inclusion criteria. CDI was mild/moderate in 55.8 percent cases, severe in 42.4 percent and fulminant in 0.5 percent. There were 1.3 percent who received prophylactic treatment.
Overall institutional guideline adherence was close to half at 51.9 percent. Bivariate analyses revealed five factors associated with nonadherence to guidelines: older age, intensive care unit (ICU) admission, duration of antibiotics, mild/moderate and severe infection (p<0.05 for all).
Logistic regression model showed that severe infection (p<0.001) and longer duration of antibiotics (p<0.05) were independently correlated with adherence to guidelines.
The investigators carried out a retrospective analysis of electronic medical record to evaluate adherence to institutional guidelines. Data on demographics were collected, as well as other factors potentially contributing to adherence, namely Charlson comorbidity index, severity of infection, recurrence, ICU admission, infectious disease consult, total duration and number of antibiotics, alternative therapies, and acid suppression.
Factors associated with guideline adherence were described and compared using descriptive statistics and bivariate analyses. Multivariate logistic regression was used to assess independent predictors of adherence.
“CDI is treated most often with metronidazole or vancomycin. Both have been effective in treatment of mild to moderate infection. In more severe cases, vancomycin may be more effective,” the investigators said.