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Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics

Published online by Cambridge University Press:  15 June 2022

Katia C. Halabi
Affiliation:
Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
Barbara Ross
Affiliation:
Department of Information Technology/Analytics for Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
Karen P. Acker
Affiliation:
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York Department of Pediatrics, Weill Cornell Medicine, New York, New York
Jean-Marie Cannon
Affiliation:
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
Maria Messina
Affiliation:
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
Diane Mangino
Affiliation:
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
Krystal Balzer
Affiliation:
Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
Alexandra Hill-Ricciuti
Affiliation:
Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
Daniel A. Green
Affiliation:
Department of Pathology, Columbia University Irving Medical Center, New York, New York
Lars F. Westblade
Affiliation:
Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
Christine M. Salvatore
Affiliation:
Department of Pediatrics, Weill Cornell Medicine, New York, New York
Lisa Saiman*
Affiliation:
Department of Pediatrics, Columbia University Irving Medical Center, New York, New York Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York
*
Author for correspondence: Lisa Saiman, E-mail: ls5@cumc.columbia.edu

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.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

Present affiliation: Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio

PREVIOUS PRESENTATION. Preliminary findings of this study were presented in the ICHE Abstract Supplement for Decennial 2020: Sixth International Conference on Healthcare-Associated Infections, Infection Control and Hospital Epidemiology, March 2020, volume 41, issue S1.

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