Effect of a prospective audit with intervention and feedback on Clostridioides difficile infection management
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RESEARCH ARTICLE
Effect of a prospective audit with intervention and feedback on Clostridioides difficile infection management H. Benoist1 · A. de La Blanchardière2 · A. Flatres1 · C. Isnard3 · P. Thibon4 · G. Saint‑Lorant1 Received: 13 December 2019 / Accepted: 28 April 2020 © Springer Nature Switzerland AG 2020
Abstract Background Clostridioides difficile infections are associated with morbidity and mortality in several countries. Their increasing incidence and frequent recurrence make them an urgent public health threat. The lack of adherence to international treatment guidelines for Clostridioides difficile infections is a proven mortality risk factor. Objective To evaluate long-term prescribers’ adherence to recommendations on the management of Clostridioides difficile infections and its impact on clinical outcomes after an educational and Clostridioides difficile-prospective audit with intervention and feedback period. Setting All patients admitted to a 1500-bed university hospital with positive Clostridioides difficile tests identified were included. Methods Data were collected retrospectively over a baseline period (May–November 2014) and prospectively over a Clostridioides difficile-prospective audit with intervention and feedback period (November 2015–May 2016) and an observation period (November 2017–September 2018). All Clostridioides difficile cases were reviewed by a Clostridioides difficile-prospective audit with intervention and feedback team composed of pharmacists, an infectious diseases specialist and a microbiologist to obtain a complete overview of patient records in each area of expertise. Main outcome measures Percentage of conformity to the protocol, percentage of recovery at 10 days and percentage of relapse, as well as Clostridioides difficile incidence and percentage of Fidaxomicin use. Results A total of 183 patients were included over the three periods. A significant improvement in conformity to the local protocol was observed between the intervention period (23.9%) and the observation period (67.3%) (P 38.5 °C); haemodynamic instability; signs and symptoms of peritonitis; colonic ileus; leucocytosis (> 15,000/mm3); serum creatinine (≥ 133 µM); serum lactate (≥ 5 mM); serum albumin ( 65 years; severe comorbidity (immunodeficiency,
cancer or history of malignancy, cognitive impairment, cardiovascular or respiratory or kidney diseases, diabetes, inflammatory bowel disease); continuing antibiotic and proton pump inhibitor prescription. •Fidaxomicin 200 mg PO every 12 h for 10 days. (3) In the case of non-severe non-recurrent CDI without relapse risk factors: •Metronidazole 500 mg PO every 8 h for 10 days or in intravenously if the oral route is not possible. (4) In the case of non-severe recurrent CDI: •First recurrence (fidaxomicin 200 mg PO every 12 h for 10 days •Second recurrence: oral vancomycin in a pulsed regimen over 6 weeks (125 mg every 6 h for 1 week, then 125 mg every 12 h for 1 week, then 125 mg every 24 h for 1 week, then 125 mg every 48 h for 2 weeks and finally 125 mg
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