Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes
Abstract Objective: To evaluate the impact of implementing a multi-step Clostridioides difficile infection (CDI) testing algorithm on hospital-onset (HO)-CDI rates and clinical outcomes. Design: Retrospective pre-intervention/post-intervention study. Setting: Two academic hospitals in Pittsbur...
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| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X25001809/type/journal_article |
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| author | Matthew A. Moffa Dustin R. Carr Nathan R. Shively Adriana Betancourth Nitin Bhanot Zaw Min Charmaine Abalos Arshpal Gill Salman Bangash Thomas L. Walsh |
| author_facet | Matthew A. Moffa Dustin R. Carr Nathan R. Shively Adriana Betancourth Nitin Bhanot Zaw Min Charmaine Abalos Arshpal Gill Salman Bangash Thomas L. Walsh |
| author_sort | Matthew A. Moffa |
| collection | DOAJ |
| description |
Abstract
Objective:
To evaluate the impact of implementing a multi-step Clostridioides difficile infection (CDI) testing algorithm on hospital-onset (HO)-CDI rates and clinical outcomes.
Design:
Retrospective pre-intervention/post-intervention study.
Setting:
Two academic hospitals in Pittsburgh, Pennsylvania.
Methods:
In the pre-intervention period, a standalone polymerase chain reaction (PCR) assay was used for diagnosing CDI. In the post-intervention period, positive PCR assays were reflexed to a glutamate dehydrogenase antigen test and an enzyme immunoassay for toxin A/B.
Results:
The implementation of a multi-step testing algorithm resulted in a significant reduction in HO-CDI cases per 10,000 patient days from 5.92 to 2.36 (P < 0.001). Despite the decrease in reportable HO-CDI cases, there were no significant differences in clinical outcomes such as hospital length of stay, intensive care unit admissions, and treatment courses. In addition, there was a significant reduction in all-cause 30-day readmissions in the post-intervention group, though CDI-related readmissions remained similar.
Conclusions:
The multi-step testing algorithm significantly reduced HO-CDI rates without compromising clinical outcomes. The study supports the use of a multi-step CDI testing algorithm to assist healthcare providers with CDI management decisions and potentially to reduce financial penalties burdened on healthcare systems.
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| format | Article |
| id | doaj-art-b4f77ecbdc3c4e158df45c190c0e421f |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-b4f77ecbdc3c4e158df45c190c0e421f2025-08-20T03:54:01ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2025.180Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomesMatthew A. Moffa0https://orcid.org/0000-0002-6253-7490Dustin R. Carr1https://orcid.org/0000-0001-8543-4972Nathan R. Shively2https://orcid.org/0000-0001-6163-438XAdriana Betancourth3Nitin Bhanot4Zaw Min5https://orcid.org/0000-0002-5708-954XCharmaine Abalos6Arshpal Gill7Salman Bangash8Thomas L. Walsh9Medicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USADepartment of Pharmacy, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USAMedicine Institute and Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, PA, USA Abstract Objective: To evaluate the impact of implementing a multi-step Clostridioides difficile infection (CDI) testing algorithm on hospital-onset (HO)-CDI rates and clinical outcomes. Design: Retrospective pre-intervention/post-intervention study. Setting: Two academic hospitals in Pittsburgh, Pennsylvania. Methods: In the pre-intervention period, a standalone polymerase chain reaction (PCR) assay was used for diagnosing CDI. In the post-intervention period, positive PCR assays were reflexed to a glutamate dehydrogenase antigen test and an enzyme immunoassay for toxin A/B. Results: The implementation of a multi-step testing algorithm resulted in a significant reduction in HO-CDI cases per 10,000 patient days from 5.92 to 2.36 (P < 0.001). Despite the decrease in reportable HO-CDI cases, there were no significant differences in clinical outcomes such as hospital length of stay, intensive care unit admissions, and treatment courses. In addition, there was a significant reduction in all-cause 30-day readmissions in the post-intervention group, though CDI-related readmissions remained similar. Conclusions: The multi-step testing algorithm significantly reduced HO-CDI rates without compromising clinical outcomes. The study supports the use of a multi-step CDI testing algorithm to assist healthcare providers with CDI management decisions and potentially to reduce financial penalties burdened on healthcare systems. https://www.cambridge.org/core/product/identifier/S2732494X25001809/type/journal_article |
| spellingShingle | Matthew A. Moffa Dustin R. Carr Nathan R. Shively Adriana Betancourth Nitin Bhanot Zaw Min Charmaine Abalos Arshpal Gill Salman Bangash Thomas L. Walsh Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes |
| title_full | Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes |
| title_fullStr | Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes |
| title_full_unstemmed | Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes |
| title_short | Impact of a multi-step testing algorithm on hospital-onset Clostridioides difficile rates and clinical outcomes |
| title_sort | impact of a multi step testing algorithm on hospital onset clostridioides difficile rates and clinical outcomes |
| url | https://www.cambridge.org/core/product/identifier/S2732494X25001809/type/journal_article |
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