Lack of adherence to SHEA-IDSA treatment guidelines for Clostridium difficile infection is associated with increased mortality

<span class="paragraphSection"><div class="boxTitle">Objectives</div>The objective of this study was to determine our institution's compliance with 2010 Society for Healthcare Epidemiology of America and IDSA <span style="font-style:italic;">Clostridium difficile</span> infection (CDI) treatment guidelines and their respective outcomes<span style="font-style:italic;">.</span><div class="boxTitle">Methods</div>We collected clinical parameters, laboratory values, antibiotic therapy and clinical outcomes from the electronic medical records for all patients hospitalized at our institution with a diagnosis of CDI from December 2012 to November 2013. We specifically evaluated whether SHEA-IDSA treatment guidelines were followed and evaluated the associations between guideline adherence and severe outcomes including mortality.<div class="boxTitle">Results</div>We identified 230 patients with CDI meeting inclusion criteria during the study period. Of these, 124 (54%) were appropriately treated, 46 (20%) were under-treated and 60 (26%) were over-treated. All-cause 90 day mortality was 17.4% overall; 43.5% in the under-treated group versus 12.9% in those appropriately treated (<span style="font-style:italic;">P</span> < 0.0001) and 10.9% in those appropriately treated plus over-treated (<span style="font-style:italic;">P</span> < 0.0001). Similarly, 90 day mortality attributed to CDI was 21.7% in those under-treated versus 8.9% in those appropriately treated (<span style="font-style:italic;">P</span> = 0.03) and 8.2% in those either appropriately treated or over-treated (<span style="font-style:italic;">P</span> = 0.015). Severe-complicated CDI occurred in 46 patients. In this subgroup, there was a non-significant trend towards increased mortality in under-treated patients (56.7%) compared with appropriately treated patients (37.5%, <span style="font-style:italic;">P</span> = 0.35). Under-treatment was also associated with a higher rate of CDI-related ICU transfer (17.4% versus 4.8% in those appropriately treated, <span style="font-style:italic;">P</span> = 0.023).<div class="boxTitle">Conclusions</div>Adherence to CDI treatment guidelines is associated with improved outcomes especially in those with severe disease. Increased emphasis on provision of appropriate, guideline-based CDI treatment appears warranted.</span>

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