Effect of a prospective audit with intervention and feedback on Clostridioides difficile infection management
Résumé
Background Clostridioides difcile infections are associated with morbidity and mortality in several countries. Their increasing incidence and frequent recurrence make them an urgent public health threat. The lack of adherence to international
treatment guidelines for Clostridioides difcile infections is a proven mortality risk factor. Objective To evaluate long-term
prescribers’ adherence to recommendations on the management of Clostridioides difcile infections and its impact on clinical
outcomes after an educational and Clostridioides difcile-prospective audit with intervention and feedback period. Setting All
patients admitted to a 1500-bed university hospital with positive Clostridioides difcile tests identifed were included. Methods Data were collected retrospectively over a baseline period (May–November 2014) and prospectively over a Clostridioides
difcile-prospective audit with intervention and feedback period (November 2015–May 2016) and an observation period
(November 2017–September 2018). All Clostridioides difcile cases were reviewed by a Clostridioides difcile-prospective
audit with intervention and feedback team composed of pharmacists, an infectious diseases specialist and a microbiologist to
obtain a complete overview of patient records in each area of expertise. Main outcome measures Percentage of conformity
to the protocol, percentage of recovery at 10 days and percentage of relapse, as well as Clostridioides difcile incidence and
percentage of Fidaxomicin use. Results A total of 183 patients were included over the three periods. A signifcant improvement in conformity to the local protocol was observed between the intervention period (23.9%) and the observation period
(67.3%) (P<10–3). Fidaxomicin prescriptions increased signifcantly (P=0.006). Clinical outcomes improved signifcantly
with an increase in the percentage of recovery at 10 days (P=0.001) and a decrease in the percentage of relapse (P=0.016).
The Clostridioides difcile incidence rate improved signifcantly to 1.3 per 10,000 patient-days during the observation period.
Conclusion This study shows the lasting efect of an educational and Clostridioides difcile-prospective audit with intervention and feedback period on prescribers’ adherence to recommendations and a signifcant impact on clinical outcomes.