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The impact of changing reflexive to clinician-ordered Clostridioides difficile polymerase chain reaction (PCR) testing for indeterminate cases: Cost savings without associated adverse events

Published online by Cambridge University Press:  13 April 2020

Eva L. Sullivan Open the ORCID record for Eva L. Sullivan [Opens in a new window] ,
Rohit Majumdar ,
Courtney Ortiz ,
Patricia K. Riggs  and
Nancy F. Crum-Cianflone
Eva L. Sullivan*
Affiliation:
Pharmacy Department, Scripps Mercy Hospital, San Diego, California
Rohit Majumdar
Affiliation:
Internal Medicine Department, Scripps Mercy Hospital, San Diego, California
Courtney Ortiz
Affiliation:
Pharmacy Department, Scripps Green Hospital, San Diego, California
Patricia K. Riggs
Affiliation:
Internal Medicine Department, Scripps Mercy Hospital, San Diego, California
Nancy F. Crum-Cianflone
Affiliation:
Internal Medicine Department, Scripps Mercy Hospital, San Diego, California Infectious Disease Division, Scripps Mercy Hospital, San Diego, California
*
Author for correspondence: Eva L. Sullivan, E-mail: Sullivan.Eva@scrippshealth.org
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Abstract

Objective:

To evaluate changing Clostridioides difficile infection (CDI) testing among inpatients with indeterminate enzyme immunoassay (EIA) results (antigen+/toxin−) from reflexive polymerase chain reaction (PCR) testing to clinician-ordered PCR testing.

Design:

Multicenter, before-and-after, quasi-experimental study.

Setting:

Four large urban tertiary-care hospitals.

Methods:

We evaluated two 6-month periods before and after an intervention. The primary study outcome was the change in the number of CDI diagnoses between periods. Secondary outcomes included the number of PCR tests performed, adverse events, and healthcare cost savings.

Results:

In total, 500 EIA-indeterminate C. difficile test results were evaluated: 281 before the intervention and 219 thereafter. CDI was diagnosed by PCR among EIA-indeterminate cases in 182 in the preintervention period versus 94 patients in the postintervention period (48% reduction; P < .01). PCR testing was performed in 99.6% of indeterminate cases (280 of 281; 1 not performed due to an inhibitor) in the preintervention period versus 66% (144 of 219) in the postintervention period (34% reduction; P < .01). We observed no differences between study periods in 30-day all-cause (P = .96), GI-related (P = .93), or C. difficile (P = .47) readmissions, nor in 30-day C. difficile infections (P > .99). No patient without a PCR test in the postintervention period and not treated was later diagnosed with CDI. Each reflexive PCR test not performed led to a cost savings of $4,498 per patient.

Conclusions:

Applying diagnostic stewardship to C. difficile PCR testing in the inpatient setting led to significant reductions in both testing and cases. Changing the C. difficile PCR testing algorithm for EIA-indeterminate cases from reflexive to clinician-required ordering resulted in valuable cost savings without associated adverse events.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 6 , June 2020 , pp. 684 - 690
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION. This information was presented as a poster (abstract no. 683588) at IDWeek 2019 on October 5, 2019, in Washington, DC.

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