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Published on: September 14, 2013
Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics
Katia C Halabi1, Barbara Ross2, Karen P Acker3,4
1Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.
Insights
Implementing restrictive computerized provider order entry (CPOE) significantly reduced healthcare-onset Clostridioides difficile infections (CDIs) testing and diagnosis in hospitalized children. This diagnostic stewardship approach proved effective in pediatric settings.
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.
Objective:
To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs).
Design:
We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE).
Setting:
Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution.
Methods:
In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis.
Results:
An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups (P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months (P < .001) and all ages combined (P = .003).
Conclusion:
Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.
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