[Identifying gaps between guidelines and clinical practice in Clostridium difficile infection].

Autor:	Rodríguez-Martín C; Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España., Serrano-Morte A; Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España., Sánchez-Muñoz LA; Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España. Electronic address: lsanchezmunoz@gmail.com., de Santos-Castro PA; Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, España., Bratos-Pérez MA; Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España., Ortiz de Lejarazu-Leonardo R; Servicio de Microbiología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
Jazyk:	Spanish; Castilian
Zdroj:	Revista de calidad asistencial : organo de la Sociedad Espanola de Calidad Asistencial [Rev Calid Asist] 2016 May-Jun; Vol. 31 (3), pp. 152-8. Date of Electronic Publication: 2015 Dec 19.
DOI:	10.1016/j.cali.2015.09.009
Abstrakt:	Objectives: The first aim was to determine whether patients are being treated in accordance with the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America (IDSA/SHEA) Clostridium difficile guidelines and whether adherence impacts patient outcomes. The second aim was to identify specific action items in the guidelines that are not being translated into clinical practice, for their subsequent implementation. Material and Methods: A retrospective, descriptive study was conducted over a 36 month period, on patients with compatible clinical symptoms and positive test for C. difficile toxins A and/or B in stool samples, in an internal medicine department of a tertiary medical centre. Patient demographic and clinical data (outcomes, comorbidity, risk factors) and compliance with guidelines, were examined Results: A total of 77 patients with C. difficile infection were identified (87 episodes). Stratified by disease severity criteria, 49.3% of patients were mild-moderate, 35.1% severe, and 15.6% severe-complicated. Full adherence with the guidelines was observed in only 40.2% of patients, and was significantly better for mild-moderate (71.0%), than in severe (7.4%) or severe-complicated patients (16.6%) (P<.003). Adherence was significantly associated with clinical cure (57% vs 42%), fewer recurrences (22.2% vs 77.7%), and mortality (25% vs 75%) (P<.01). The stratification of severity of the episode, and the adequacy of antibiotic to clinical severity, need improvement. Conclusions: Overall adherence with the guidelines for management of Clostridium difficile infection was poor, especially in severe and severe-complicated patients, being associated with worse clinical outcomes. Educational interventions aimed at improving guideline adherence are warranted. (Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.)
Databáze:	MEDLINE
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