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

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.