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Inappropriate Clostridium difficile Testing and Consequent Overtreatment and Inaccurate Publicly Reported Metrics

Published online by Cambridge University Press:  26 September 2016

Sean G. Kelly ,
Michael Yarrington ,
Teresa R. Zembower ,
Sarah H. Sutton ,
Christina Silkaitis ,
Michael Postelnick ,
Anessa Mikolajczak  and
Maureen K. Bolon
Sean G. Kelly*
Affiliation:
Vanderbilt University School of Medicine, Division of Infectious Diseases, Nashville, Tennessee
Michael Yarrington
Affiliation:
Northwestern Feinberg School of Medicine, Department of Medicine, Chicago, Illinois
Teresa R. Zembower
Affiliation:
Vanderbilt University School of Medicine, Division of Infectious Diseases, Nashville, Tennessee Northwestern Memorial Hospital, Department of Healthcare Epidemiology and Infection Prevention, Chicago, Illinois
Sarah H. Sutton
Affiliation:
Vanderbilt University School of Medicine, Division of Infectious Diseases, Nashville, Tennessee Northwestern Memorial Hospital, Department of Healthcare Epidemiology and Infection Prevention, Chicago, Illinois
Christina Silkaitis
Affiliation:
Northwestern Memorial Hospital, Department of Healthcare Epidemiology and Infection Prevention, Chicago, Illinois
Michael Postelnick
Affiliation:
Northwestern Memorial Hospital, Department of Pharmacy, Chicago, Illinois
Anessa Mikolajczak
Affiliation:
Northwestern Memorial Healthcare, Department of Healthcare Epidemiology and Infection Prevention, Winfield, Illinois
Maureen K. Bolon
Affiliation:
Vanderbilt University School of Medicine, Division of Infectious Diseases, Nashville, Tennessee Northwestern Memorial Hospital, Department of Healthcare Epidemiology and Infection Prevention, Chicago, Illinois
*
Address correspondence to Sean G. Kelly, MD, 1161 21st Ave South, Ste A2200, Nashville, TN 37232 ([email protected]).
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Abstract

BACKGROUND

The nationally reported metric for Clostridium difficile infection (CDI) relies solely on laboratory testing, which can result in overreporting due to asymptomatic C. difficile colonization.

OBJECTIVE

To review the clinical scenarios of cases of healthcare facility-onset CDI (HO-CDI) and to determine the appropriateness of C. difficile testing on the basis of presence of symptomatic diarrhea in order to identify areas for improvement.

DESIGN

Retrospective cohort study.

SETTING

Northwestern Memorial Hospital, a large, tertiary academic hospital in Chicago, Illinois.

PATIENTS

The cohort included all patients with a positive C. difficile test result who were reported to the National Healthcare Safety Network as HO-CDI during a 1-year study period.

METHODS

We reviewed the clinical scenario of each HO-CDI case. On the basis of documentation and predefined criteria, appropriateness of C. difficile testing was determined; cases were deemed appropriate, inappropriate, or indeterminate. Statistical analysis was performed to compare demographic and clinical parameters among the categories of testing appropriateness.

RESULTS

Our facility reported 168 HO-CDI cases to NHSN during the study period. Of 168 cases, 33 (19.6%) were judged to be appropriate tests, 25 (14.8%) were considered inappropriate, and 110 (65.5%) were indeterminate. Elimination of inappropriate testing would have improved our facility’s standardized infection ratio from 0.962 to 0.819.

CONCLUSION

Approximately 15% of HO-CDI cases were judged to be tested inappropriately. Testing only patients with clinically significant diarrhea would more accurately estimate CDI incidence, reduce unnecessary antibiotic use, and improve facilities’ performance of reportable CDI metrics. Improved documentation could facilitate targeted interventions.

Infect Control Hosp Epidemiol 2016;1395–1400

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 12 , December 2016 , pp. 1395 - 1400
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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