Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics.

Autor:	Halabi KC; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York., Ross B; Department of Information Technology/Analytics for Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York., Acker KP; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York.; Department of Pediatrics, Weill Cornell Medicine, New York, New York., Cannon JM; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York., Messina M; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York., Mangino D; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York., Balzer K; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York., Hill-Ricciuti A; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York., Green DA; Department of Pathology, Columbia University Irving Medical Center, New York, New York., Westblade LF; Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York., Salvatore CM; Department of Pediatrics, Weill Cornell Medicine, New York, New York., Saiman L; Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2023 Feb; Vol. 44 (2), pp. 186-190. Date of Electronic Publication: 2022 Jun 15.
DOI:	10.1017/ice.2022.117
Abstrakt:	Objective: To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs). Design: We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE). Setting: Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution. Methods: In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis. Results: An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups ( P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months ( P < .001) and all ages combined ( P = .003). Conclusion: Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.
Databáze:	MEDLINE
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