Clostridium difficile-associated disease:Adherence with current guidelines at a tertiary medical center  

作　　者：Bryan F Curtin Yousef Zarbalian Mark H Flasar Erik von Rosenvinge 

机构地区：[1]Resident in Internal Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore [2]Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore

出　　处：《World Journal of Gastroenterology》2013年第46期8647-8651,共5页世界胃肠病学杂志（英文版）

摘　　要：AIM:To assess adherence with the the Society for Healthcare Epidemiology of America(SHEA)/the Infectious Diseases Society of America(IDSA)guidelines for management of Clostridium difficile(C.difficile)-associated disease(CDAD)at a tertiary medical center.METHODS:All positive C.difficile stool toxin assays in adults between May 2010 and May 2011 at the University of Maryland Medical Center were identified.CDAD episodes were classified as guideline adherent or nonadherent and these two groups were compared to determine demographic and clinical factors predictive of adherence.Logistic regression analysis was performed to assess the effect of multiple predictors on guideline adherence.RESULTS:320 positive C.difficile stool tests were identified in 290 patients.Stratified by disease severity criteria set forth by the SHEA/IDSA guidelines,42.2%of cases were mild-moderate,48.1%severe,and 9.7%severe-complicated.Full adherence with the guidelines was observed in only 43.4%of cases.Adherence was65.9%for mild-moderate CDAD,which was significantly better than in severe cases(25.3%)or severe-complicated cases(35.5%)(P<0.001).There was no difference in demographics,hospitalization,ICU exposure,recurrence or 30-d mortality between adherent and non-adherent groups.A multivariate model revealed significantly decreased adherence for severe or severecomplicated episodes(OR=0.18,95%CI:0.11-0.30)and recurrent episodes(OR=0.46,95%CI:0.23-0.95).CONCLUSION:Overall adherence with the SHEA/IDSA guidelines for management of CDAD at a tertiary medical center was poor;this was most pronounced in severe,severe-complicated and recurrent cases.Educational interventions aimed at improving guideline adherence are warranted.AIM: To assess adherence with the the Society for Healthcare Epidemiology of America (SHEA)/ the Infectious Diseases Society of America (IDSA) guidelines for management of Clostridium difficile (C. difficile)-associated disease (CDAD) at a tertiary medical center.

关 键 词：CLOSTRIDIUM DIFFICILE METRONIDAZOLE Vanco-mycin ADHERENCE to the Infectious Diseases Society of America GUIDELINES Hospital Acquired Infections 

分 类 号：R516[医药卫生—内科学]