{"id":3050,"date":"2021-02-04T12:07:20","date_gmt":"2021-02-04T17:07:20","guid":{"rendered":"https:\/\/www.med.unc.edu\/casp\/?p=3050"},"modified":"2021-02-04T12:34:02","modified_gmt":"2021-02-04T17:34:02","slug":"c-difficile-infection-guideline-developed-to-aid-testing-and-treatment-decision-making","status":"publish","type":"post","link":"https:\/\/www.med.unc.edu\/casp\/2021\/02\/c-difficile-infection-guideline-developed-to-aid-testing-and-treatment-decision-making\/","title":{"rendered":"C. difficile infection guideline developed to aid testing and treatment decision-making"},"content":{"rendered":"

In January, the UNC Medical Center\u2019s Anti-infectives Sub-committee approved a new Clostridioides difficile<\/em>, or C. difficile<\/em>, infection guideline<\/a> to provide evidence-based best practices for diagnosis and management of the disease. The US Centers for Disease Control and Prevention estimates that CDI sickens an estimated 462,000 people in the US, leading to some 15,000 deaths each year. Lindsay Daniels chairs the sub-committee and is also the pharmacy lead for the Carolina Antimicrobial Stewardship Program (CASP) at UNCMC.<\/p>\n

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Wilson<\/figcaption><\/figure>\n

As a part of CASP\u2019s years-long collaboration<\/a> with the Healthcare-associated Infections Prevention Initiative (formerly the C. difficile<\/em> Workgroup), a small group of experts led by UNC Children\u2019s pediatric infectious diseases pharmacist and CASP member Bill Wilson developed the guideline. \u201cThe group benefited from the complementary lenses each person brought from their respective disciplines, from infection prevention to pharmacy to microbiology,\u201d Wilson shared. \u201cBecause of the collaboration, we were able to deepen our understanding of each person\u2019s role in the management of CDI. It allowed us to determine what areas of CDI management we each felt were most important to include in the guideline to best assist clinicians in appropriately diagnosing and treating CDI\u201d. The guideline is tailored to the Medical Center\u2019s existing microbiology lab procedures and pharmacy formulary. Kevin Alby, Tom Belhorn, Nikolaos Mavrogiorgos, Shelley Summerlin-Long, Kate Schultz, and Amy Selimos contributed to the guideline\u2019s development.<\/p>\n

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Click the image to view the guideline (UNC Health log-in required)<\/figcaption><\/figure>\n

The Medical Center drove down CDI rates a remarkable 42% following the implementation of a set of evidence-based practices, or a \u201cbundle,\u201d in 2016. Since that time, the HAI Prevention Initiative has continued to develop ways to lower infections further. The guideline is the latest contribution to those efforts.<\/p>\n

Recent data from Infection Prevention shows that clinicians sometimes order tests for C. difficile<\/em> even when the patient\u2019s stool does not meet testing criteria. This can result in a positive test for C. difficile<\/em> because the bacteria may be present in a healthy gut and only becomes pathogenic when conditions (such as recent antibiotic use) cause the bacteria to flourish. In cases where a test is ordered inappropriately and C. difficile<\/em> is detected, treatment may be started unnecessarily, leading to additional antibiotic exposure that is otherwise not needed. To help prevent this, UNCMC\u2019s McLendon Lab, which tests microbiology samples, uses tests that can help a healthcare provider discern the difference between colonization and infection. The group of experts developing the guideline identified this as a common area of confusion for clinicians. For that reason, the guideline includes a section reviewing when it is appropriate to send a test for C. difficile<\/em> and how the microbiology lab processes each sample to reduce overtreatment.<\/p>\n

The guideline helps providers determine what actions to take based on microbiology lab results, the severity of symptoms, and whether or not the patient has had CDI in the past. For example, it recommends:<\/p>\n