Effect of treatment variation on outcomes in patients with Clostridium Difficile associated diarrhea

Purpose: New guidelines for the treatment of Clostridium difficile associated diarrhea (CDAD) in adults were published by the Infectious Disease Society of America (IDSA) in 2010, however there has been no literature evaluating the effectiveness of these guidelines.  The purpose of this study is to examine the difference in clinical outcomes of CDAD patients treated according to the guidelines compared to patients that were not treated according to the guidelines.

Methods: Using data retrospectively collected from University Medical Center’s electronic records, we compared the complication rates (death, infection recurrence, toxic megacolon and surgery) of patients with CDAD to determine if following the IDSA Guidelines improves outcomes.

Results: Only 51.7% of the patients’ prescribers followed the 2010 IDSA CDAD guidelines.  Patients whose prescribers followed the IDSA Guidelines experienced fewer complications than patients whose prescribers strayed from the guidelines (17.2% vs. 56.3%, p<0.0001).  This difference was mainly due to a reduction in mortality (5.4% vs. 21.8%, p=0.0012) and infection recurrence (14% vs. 35.6%, p=0.0007).  Patients who presented with severe and complicated disease received guideline based therapy significantly less often than patients with mild disease (35.3% and 19.7% vs. 81.2% respectively, p<0.0001).  Patients infected with a NAP-1 strain exhibited more severe disease (SAPS II 22.5 vs. 22, p=0.0003) and had higher mortality (22.9% vs. 7.3%, p=0.0027) than those infected with a non-NAP-1 strain.

Conclusion: There was a significant reduction in complications from CDAD associated with treatment plans that were consistent with recommendations in the IDSA Guidelines.