“Diagnostic Stewardship” –Reducing Unnecessary Clostridioides difficile Treatment by Changing Testing Approach

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D Ilges, et al.  Infection Control & Hospital Epidemiology. Published online 2024:1-6. doi:10.1017/ice.2024.180. Open Access! Positive impact of a diagnostic stewardship intervention on syndromic panel ordering practices and inappropriate C. difficile treatment.

In this retrospective study, the authors examined the impact of removing C diff (Clostridioides difficile) testing from a  gastrointestinal pathogen panel (GIPP) and only testing with preferred method which consisted of glutamate dehydrogenase and toxin antigen immunoassay, followed by toxin gene testing for discrepant result.

Key findings:

  • At baseline (prior to implementing a change), the most common positive target was C. diff (517 of 1,018, 51%), which resulted in treatment for C. difficile infection in 94.9% (337 of 355) of cases.
  • Following GIPP C. diff target removal, GIPP orders decreased from 3.23 to 2.7 per 1,000 patient visits (P < .001). Standalone C. diff testing increased from 0.92 to 3.06 per 1,000 patient visits (P < .001).
  • Outpatient C. diff prescriptions declined over the study, with a mean of 2.36 per 1,000 outpatient visits in the baseline period and 1.81 per 1,000 outpatient visits in the postintervention period (P = <.001). For the inpatient setting, days of therapy (DOT) per 1,000 decreased from 13.77 in the baseline period to 10.58 in the postintervention period, though the reduction did not meet statistical significance (P = .051).

My take: This study shows the benefit of removing C. diff from GIPPs to drive more appropriate testing and targeted treatment. GIPPs, while convenient, often identify C. diff colonization. This approach is cost-effective and reduces harms of unnecessary antibiotic treatment.

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