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Impact of real-time notification of Clostridium difficile test results and early initiation of effective antimicrobial therapy

Published:January 03, 2018DOI:https://doi.org/10.1016/j.ajic.2017.11.010

      Highlights

      • No studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of Clostridium difficile infection (CDI).
      • The implementation of a real-time notification system to alert a pharmacist-led ASP of CDI is a valuable strategy for decreasing time to effective antimicrobial therapy.
      • Real-time notification may lead to increased compliance and time to implementation of contact precautions.

      Background

      Clostridium difficile is a prominent nosocomial pathogen and is the most common causative organism of health care–associated diarrhea. To our knowledge, no studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of C difficile infection (CDI). The purpose of this study was to assess the impact of real-time notification of detection of toxigenic C difficile by DNA amplification results in patients with confirmed CDI.

      Methods

      This is a single-center, retrospective cohort study at a 433-bed tertiary medical center in central Kentucky. The study consisted of 2 arms: patients treated for CDI prior to implementation of real-time provider notification and patients postimplementation. The primary outcome was time to initiation of effective antimicrobial therapy.

      Results

      The median time to initiation of effective antimicrobial therapy decreased from 5.75 hours in the preimplementation cohort to 2.05 hours in the postimplementation cohort (P = .001). ASP intervention also resulted in a shorter time from detection of CDI to order entry of effective antimicrobial therapy in the patient's electronic medical record (3.0 vs 0.6 hours; P = .001).

      Conclusions

      The implementation of a real-time notification system to alert a pharmacist-led ASP of toxigenic CDI resulted in statistically significant shorter times to order entry and subsequent initiation of effective antimicrobial therapy and contact precautions.

      Key Words

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