Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates.

摘要: Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. colonization and inability hospitals to limit testing patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 30 2016 on consecutive inpatients test orders at an academic hospital. Real-time electronic patient data tracking was used by laboratory enforce criteria (defined as presence diarrhea [≥3 unformed stools in 24 h] absence laxative intake prior 48 h). Outcome measures included utilization, HO-CDI incidence, oral vancomycin clinical complications. During intervention, 7.1% (164) 9.1% (211) 2,321 were canceled due receipt therapy, respectively. utilization decreased upon implementation average 208.8 tests 143.0 per 10,000 patient-days (P < 0.001). incidence rate 13.0 cases 9.7 = 0.008). Oral days therapy 13.8 9.4 1,000 0.009). Clinical complication rates not significantly different 375 compared 869 episodes but negative results. effective tool verification safe reduction inflated rates.