C. difficile patients diagnosed with PCR, NAATs more often receive prompt treatment
BOSTON — Clostridium difficile patients whose illness was diagnosed using PCR or nucleic acid amplification tests, or NAATs, more frequently received treatment within 4 hours compared with those who were diagnosed using other techniques, according to data presented here at ASM Microbe 2016.
“With any infection, it’s very important to start therapy quickly since it improves patients’ outcomes and mortality,” Mandelin Cooper, PharmD, corporate director of clinical pharmacy at the Hospital Corporation of America, told Infectious Disease News. “C. difficile is one of those things that we all worry about, and you can die from it, so we would like these patients on therapy as soon as possible.”
Hospital Corporation of America employs a real-time clinical surveillance tool (RTCST), which pulls data from patients’ electronic health records and alerts clinical pharmacists to intervene and prevent adverse drug events. Cooper and colleagues conducted a retrospective study of patients at 83 hospitals from Nov. 1, 2014 to June 30, 2015, who triggered an RTCST alert for C. difficile infection (CDI). The researchers compared the frequency of appropriate antimicrobial therapy administered within 4 hours of a positive C. difficile test result between patients who were diagnosed using PCR or NAATs (n = 1,156) and those who were diagnosed using any other “conventional” technique (n = 592). Secondary outcomes included average length of stay (LOS) and in-hospital mortality.
Patient demographics were comparable between the two study groups, although those who underwent conventional testing were, on average, 4 years older. All patients received similar antibiotic therapies for their infections.
Patients diagnosed with PCR or NAATs more often received appropriate therapy within 4 hours of RTCST notification than those who were diagnosed by other techniques (41.9% vs. 27.4%; P < .001). There was no significant difference in LOS or in-hospital mortality between the two groups. When limiting their analysis to those who received treatment within 4 hours, the PCR and NAATs group had a shorter median time from sample collection to treatment administration (6.6 hours vs. 16.1 hours; P < .001), and a shorter median time from sample collection to receipt of clinical results (4.1 hours vs. 13.4 hours; P < .001).
In light of these findings, Cooper recommended that providers who currently use conventional techniques perform a thorough examination of the testing process and the time it takes to receive clinical results.
“It should not take 13 hours, as even conventional tests have fast turnaround times,” Cooper said. “That is a significant delay. If it is, see how well you’re doing with your patients — with testing, with starting a therapy and with discontinuing other antibiotics — because this is one of the many important pieces of C. difficile.” — by Dave Muoio
Burgess H, et al. Abstract Friday-296. Presented at: ASM Microbe; June 16-20, 2016; Boston.
Disclosure: The researchers report no relevant financial disclosures.