Hospital-Onset CDI Rates Drop Significantly After Approval Required for Testing

After an academic hospital began requiring infectious disease specialist approval for testing, hospital-onset Clostridioides difficile infection (CDI) rates dropped more than half, according to study results published in Clinical Infectious Diseases.

“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,” wrote corresponding author Michael Y. Lin, MD, and study coauthors from Rush University Medical Center, Chicago, Illinois.

The retrospective study focused on hospital-onset CDI testing at a 697-bed academic hospital between March 1, 2012, and December 31, 2019. Researchers compared hospital-onset CDI rates over three periods: baseline 1, which featured no decision support for 37 months; baseline 2, which featured computer decision support for 32 months; and intervention, which featured mandatory infectious disease specialist approval for all CDI testing on hospital day 4 or later and which lasted 25 months.

According to the study, requests for hospital-onset CDI testing during the intervention period ranged between 0 and 6 per day. The median was one request per day. Health care providers showed 85% adherence with obtaining approval.

Rates of hospital-onset CDI rates per 10,000 patient days were 10.2 with no decision support during baseline 1, 10.4 with computer decision support during baseline 2, and 4.3 during the mandatory infectious disease specialist approval intervention, the study found.

“An infectious disease-led C. difficile testing approval process was feasible and associated with a >50% decrease in hospital-onset CDI rates, due to enforcement of appropriate testing,” researchers reported.

Reference:
Lin MY, Stein BD, Kothadia SM, et al. Impact of mandatory infectious disease specialist approval on hospital-onset Clostridioides difficile infection rates and testing appropriateness. Clin Infect Dis. Published online May 9, 2023. doi:10.1093/cid/ciad250