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Updated: Jul 27, 2025
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Implementation of a multidisciplinary process to improve diagnostic stewardship of hospital-onset Clostridioides
Charles Bussell1, Jennifer Vincent2, Karen Brust3
1Department of Internal Medicine, Baylor Scott & White Medical Center-Temple, Temple, TX; Division of Gastroenterology, Department of Internal Medicine, Baylor Scott & White Medical Center-Temple, Temple, TX.
Background:
Testing inappropriate stool samples for Clostridioides (Clostridium) difficile can lead to the identification of the patient colonized with C difficile and erroneous diagnosis of an active infection. We hypothesized that a multidisciplinary process to improve diagnostic stewardship could reduce our numbers of hospital-onset C difficile infection (HO-CDI).
Methods:
We created an algorithm describing appropriate stool specimens for polymerase chain reaction testing. The algorithm was converted into "ticket to test" checklist cards designed to accompany each specimen. Rejection of a specimen could occur via nursing staff or laboratory staff.
Results:
A baseline period of comparison was established from January 1, 2017 to June 30, 2017. Following implementation of all improvement strategies, a retrospective analysis was done, and the total number of HO-CDI cases in a 6-month period dropped from 57 to 32 cases. During the initial 3 months, the percentage of appropriate samples sent to the lab ranged from 41% to 65%. After the interventions were in place, the percentages improved between 71% and 91%.
Conclusions:
A multidisciplinary approach led to improved diagnostic stewardship to identify true CDI cases. This, in turn, reduced the number of reported HO-CDIs, and resulted in potentially more than $1,080,000 in patient care savings.
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