Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics.

Area of Science:

• Pediatric Infectious Diseases
• Clinical Microbiology
• Healthcare Quality Improvement

Background:

• Healthcare-onset Clostridioides difficile infections (CDIs) pose a significant challenge in pediatric populations.
• Inappropriate testing for CDI contributes to increased healthcare costs and potential misdiagnosis.

Purpose of the Study:

• To reduce inappropriate testing and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs) in hospitalized children.
• To evaluate the impact of restrictive computerized provider order entry (CPOE) on CDI testing and diagnosis.

Main Methods:

• Retrospective analysis of CDI testing data before and after CPOE implementation in two children's hospitals.
• Utilized interrupted time series analysis and Mann-Whitney U test to assess changes in testing and diagnosis rates.
• Implemented age-based restrictions and required approvals for CDI testing.

Main Results:

• Significant decrease in the number of CDI tests ordered and samples sent across all age groups post-CPOE implementation (P < .05).
• Significant reduction in the monthly median number of HO-CDI cases in children aged 13-23 months (P < .001) and overall (P = .003).

Conclusions:

• Restrictive CPOE for CDI diagnosis in pediatrics is a successful and sustainable strategy.
• Diagnostic stewardship for CDI can lead to cost savings, reduced misdiagnosis, and decreased unnecessary antibiotic use.