A retrospective study investigating the management, risk factors, and outcomes of patients diagnosed with Clostridioides difficile infection

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2023-09-12 DOI:10.1002/jppr.1881

Mitt M. Vongphakdi BPharm(Hons), Nicholas Ah Yui BPharm, GCClinPharm, Kevin OCallaghan MB BCh BAO, MPHTM, FRACP

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引用次数: 0

Abstract

Background

The rate of clostridioides difficile infection (CDI) in Australia has increased by more than 8% between 2016–2018. This can be attributed to multiple factors including an ageing population, widespread antibiotic and proton-pump-inhibitor usage.

Aim

The aim of this study was to investigate the management, risk factors and outcomes for CDI to identify strategies to reduce its incidence.

Method

A single-centre retrospective audit was completed using medical records for patients admitted to a 250-bed regional Queensland hospital with CDI in 2020–2021. Data surrounding CDI management for each patient was analysed against the Therapeutic Guidelines. This study was approved by The Prince Charles Hospital Human Research Ethics Committee (Reference No: LNR/HREC/QPCH/81287).

Results

There were 72 cases with CDI during the study timeframe. Recent antibiotic prescription, proton-pump-inhibitor (PPI) use and antibiotic allergy labels were common. Thirty-five per cent of cases were treated appropriately. Eight per cent died, and nine per cent had relapsed CDI within 12 weeks of diagnosis. Common gaps found in the results included inappropriate selection of antibiotics based on the severity of disease and lack of documentation surrounding CDI cases left untreated.

Conclusion

There are multiple opportunities for pharmacists to improve the care of patients with CDI which range from promoting guideline adherence, influencing prescriber antibiotic selection based on disease severity, prompting review of PPIs upon CDI diagnosis and prompting provider follow-up of CDI laboratory results pending at the point of patient discharge. The results of this study have prompted antimicrobial stewardship service review of all CDI admissions at the study site and indicates the need for a larger multiple-site study to raise awareness of CDI risk factors and severity criteria.

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一项回顾性研究调查诊断为艰难梭菌感染的患者的管理、危险因素和结局

2016-2018年间，澳大利亚艰难梭菌感染率(CDI)增加了8%以上。这可归因于多种因素，包括人口老龄化，抗生素和质子泵抑制剂的广泛使用。目的本研究的目的是探讨CDI的管理、危险因素和结果，以确定降低其发病率的策略。方法采用单中心回顾性审计方法，对昆士兰州一家拥有250个床位的地区医院2020-2021年收治的CDI患者的医疗记录进行审计。根据治疗指南对每位患者的CDI管理数据进行分析。本研究已获查尔斯王子医院人类研究伦理委员会批准(参考编号:LNR/HREC/QPCH/81287)。结果研究期间共发生72例CDI。最近的抗生素处方、质子泵抑制剂(PPI)使用和抗生素过敏标签是常见的。35%的病例得到了适当的治疗。8%的患者死亡，9%的患者在确诊后的12周内复发。在结果中发现的常见差距包括根据疾病严重程度不适当地选择抗生素，以及缺乏关于未经治疗的CDI病例的记录。结论药师有多种机会改善CDI患者的护理，包括促进指南的遵守，根据疾病严重程度影响处方抗生素的选择，在CDI诊断时提示PPIs的审查，以及在患者出院时提示提供者对CDI实验室结果的随访。这项研究的结果促使对研究地点所有CDI入院的抗菌药物管理服务进行审查，并表明需要进行更大规模的多地点研究，以提高对CDI风险因素和严重程度标准的认识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.