Abstract
This study was conducted to investigate the adherence to clinical practice guidelines (CPGs) for Clostridium difficile infection (CDI). A retrospective multicenter observational study was conducted via chart review at four teaching hospitals in Japan from April 2012 through September 2013. CDI was diagnosed based on positive identification of CD toxin by enzyme immunoassay testing. CDI patients were divided into non-severe and severe groups according to the severity criteria of four published guidelines (SHEA/IDSA 2010, ACG 2013, ESCMID 2009, HPA/DH 2008). Three parameters were assessed in association with disease severity: adherence to treatment guidelines, prognosis, and relapse rate. In total, 170 patients were diagnosed with CDI (1.04 cases per 10,000 patient-days). The 30-day all-cause mortality and recurrence rates were 13% and 14%, respectively. CPGs adherence ranged from 52% to 70% in the non-severe group and from 8.5 to 23% in the severe group (P < 0.01). Among severe CDI patients, no significant difference in mortality or recurrence was found between the patients whose treatments adhered and did not adhere to the CPGs. CPGs adherence was low, especially for patients with severe CDI. Improved guideline adherence and more accurate definitions of severity based on prognosis are needed for appropriate CDI management.
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Acknowledgments
We would like to express our appreciation to the staff at our clinical microbiology laboratories for performing the tests and helping us with the data collection.
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KK, NS, YA, and HK designed the study. KK, NS, YA, and HK collected and analyzed the data. The initial manuscript was written by KK and NS, then critically reviewed by KK, NS, YA, HK, and AI. All of the authors have seen the submitted manuscript and given their final approval on its publication.
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There are no competing financial interests.
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This study was approved by all participating institutional ethical committees and carried out in accordance with the ethical guidelines for clinical research of the Ministry of Health, Labor, and Welfare in Japan.
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Informed consent is not required for this type of retrospective study.
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Kobayashi, K., Sekiya, N., Ainoda, Y. et al. Adherence to clinical practice guidelines for the management of Clostridium difficile infection in Japan: a multicenter retrospective study. Eur J Clin Microbiol Infect Dis 36, 1947–1953 (2017). https://doi.org/10.1007/s10096-017-3018-4
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DOI: https://doi.org/10.1007/s10096-017-3018-4