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Updated: Jul 31, 2025
A Protein Microarray Assay for Serological Determination of Antigen-specific Antibody Responses Following Clostridium difficile Infection
Published on: June 15, 2018
Impact of Mandatory Infectious Disease Specialist Approval on Hospital-Onset Clostridioides difficile Infection Rates
Michael Y Lin1, Brian D Stein1, Sonya M Kothadia1
1Departments of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Background:
Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear.
Methods:
At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates.
Results:
During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0-6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P = .14) but did differ between the baseline 2 period and intervention period (P < .001).
Conclusions:
An ID-led C. difficile testing approval process was feasible and was associated with a >50% decrease in HO-CDI rates, due to enforcement of appropriate testing.
Insights
Implementing infectious diseases (ID) specialist approval for Clostridioides difficile testing significantly reduced hospital-onset CDI rates. This intervention demonstrated feasibility and effectiveness in optimizing diagnostic practices.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Clinical Microbiology
Background:
- Inappropriate Clostridioides difficile testing is prevalent in hospitals, potentially leading to overdiagnosis.
- The impact of infectious diseases (ID) specialists on optimizing C. difficile testing protocols remains under-explored.
Purpose of the Study:
- To evaluate the feasibility and impact of an ID specialist-led approval process for C. difficile testing.
- To assess the effect of this intervention on hospital-onset C. difficile infection (HO-CDI) rates.
Main Methods:
- A retrospective study was conducted at a 697-bed academic hospital over 94 months (March 2012-December 2019).
- Hospital-onset C. difficile infection (HO-CDI) rates were compared across three periods: baseline (no decision support), baseline with computer decision support, and intervention with mandatory ID specialist approval for testing on or after hospital day 4.
- A discontinuous growth model was used to analyze HO-CDI rate changes.
Main Results:
- The HO-CDI rate decreased from 10.2 and 10.4 events per 10,000 patient-days during baseline periods to 4.3 events per 10,000 patient-days during the intervention period.
- The intervention demonstrated a statistically significant reduction in HO-CDI rates (P < .001) compared to the baseline periods.
- Provider adherence to the testing approval process was 85%, with a median of one approval request per day during the intervention.
Conclusions:
- An infectious diseases specialist-led C. difficile testing approval process is feasible in a hospital setting.
- This intervention was associated with a greater than 50% reduction in hospital-onset C. difficile infection rates.
- Enforcing appropriate testing through specialist approval effectively reduces HO-CDI incidence.
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