Clostridioides difficile Near-Patient Testing Versus Centralized Testing: A Pragmatic Cluster Randomized Crossover...

Area of Science:

• Infectious Diseases
• Healthcare Management
• Clinical Diagnostics

Background:

• Suspected Clostridioides difficile infection (CDI) management involves isolation, testing, and treatment.
• Current practices may lead to prolonged isolation, unnecessary antibiotic use, and increased costs.
• The study investigates the impact of rapid near-patient testing (NPT) on CDI management efficiency.

Purpose of the Study:

• To evaluate the effectiveness of rapid near-patient testing (NPT) in reducing patient isolation time.
• To assess the impact of NPT on hospital length of stay (LOS), antibiotic usage, and healthcare costs associated with CDI.

Main Methods:

• A 2-period pragmatic cluster randomized crossover trial involving 39 hospital wards.
• Primary outcome: patient isolation time; Secondary outcomes: hospital LOS, antibiotic therapy.
• Analyses included natural experiment (NE), intention-to-treat (ITT), and per-protocol (PP) approaches.

Main Results:

• NPT significantly decreased patient isolation time (NE: 9.4 hrs, ITT: 2.3 hrs, PP: 6.7 hrs).
• NPT led to significant reductions in hospital LOS (NE: 47.4%, ITT: 18.4%, PP: 34.2%).
• NPT resulted in cost savings of $25.48 per patient and reduced antibiotic use.

Conclusions:

• Implementation of CDI NPT significantly reduces patient isolation duration.
• NPT contributes to shorter hospital LOS and decreased antibiotic consumption.
• Rapid near-patient testing offers a cost-effective strategy for managing suspected CDI in hospitals.