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Reductions in Clostridium difficile Infection (CDI) Rates Using Real-Time Automated Clinical Criteria Verification to Enforce Appropriate Testing

  • Kathleen A. Quan (a1), Jennifer Yim (a1), Doug Merrill (a2), Usme Khusbu (a1), Keith Madey (a1), Linda Dickey (a1), Amish A. Dangodara (a3) (a4), Scott E. Rudkin (a5) (a4), Margaret O’Brien (a4), Daniel Thompson (a4), Nimisha Parekh (a3) (a6), C. Gregory Albers (a3) (a6), William C. Wilson (a3) (a7) (a8), Lauri Thrupp (a1) (a9), Cassiana E. Bittencourt (a10), Susan S. Huang (a1) (a9) and Shruti K. Gohil (a1) (a9)...


Corresponding author

Address correspondence to Shruti K. Gohil, MD, MPH, Assistant Professor, University of California, Irvine, School of Medicine, UC Irvine Health, 101 The City Drive, Bldg 56, Suite 700, Rte 181, Orange, CA 92868 (


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1. Lessa, FC, Mu, Y, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med Feb 26 2015;372:825834.
2. Polage, CR, Gyorke, CE, Kennedy, MA, et al. Overdiagnosis of Clostridium difficile infection in the molecular test era. JAMA Intern Med Nov 2015;175:17921801.
3. Furuya-Kanamori, L, Clements, AC, Foster, NF, et al. Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014: prospective, repeated cross-sectional study. Clin Microbiol Infect 2017;23:48 e41e48.
4. Burnham, CA, Carroll, KC. Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories. Clin Microbiol Rev 2013;26:604630.
5. Cohen, SH, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431455.
6. Surawicz, CM, Brandt, LJ, Binion, DG, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol 2013;108:478498; quiz 499.
7. Sittig, DF, Singh, H. Electronic health records and national patient-safety goals. N Engl J Med 2012;367:18541860.
8. Isaac, S, Scher, JU, Djukovic, A, et al. Short- and long-term effects of oral vancomycin on the human intestinal microbiota. J Antimicrob Chemother 2017;72:128136.
9. Vrieze, A, Out, C, Fuentes, S, et al. Impact of oral vancomycin on gut microbiota, bile acid metabolism, and insulin sensitivity. J Hepatol Apr 2014;60:824831.
10. Al-Nassir, WN, Sethi, AK, Li, Y, Pultz, MJ, Riggs, MM, Donskey, CJ. Both oral metronidazole and oral vancomycin promote persistent overgrowth of vancomycin-resistant enterococci during treatment of Clostridium difficile–associated disease. Antimicrob Agents Chemother Jul 2008;52:24032406.
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Supplementary materials

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Supplementary materials

Quan et al. supplementary material
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