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Clostridium difficile-associated disease:Adherence with current guidelines at a tertiary medical center

World Journal of Gastroenterology 2013年第46期19卷 8647-8651页

作者： Bryan F Curtin yousef zarbalian Mark H Flasar Erik von Rosenvinge Resident in Internal Medicine Department of Medicine University of Maryland School of Medicine Baltimore Division of Gastroenterology and Hepatology Department of Medicine University of Maryland School of Medicine and VA Maryland Health Care System Baltimore

AIM:To assess adherence with the the Society for Healthcare Epidemiology of America(SHEA)/the Infectious Diseases Society of America(IDSA)guidelines for management of Clostridium difficile(***)-associated disease(CDAD)at a tertiary medical ***:All positive *** stool toxin assays in adults between May 2010 and May 2011 at the University of Maryland Medical Center were *** episodes were classified as guideline adherent or nonadherent and these two groups were compared to determine demographic and clinical factors predictive of *** regression analysis was performed to assess the effect of multiple predictors on guideline ***:320 positive *** stool tests were identified in 290 *** by disease severity criteria set forth by the SHEA/IDSA guidelines,42.2%of cases were mild-moderate,48.1%severe,and 9.7%*** adherence with the guidelines was observed in only 43.4%of *** was65.9%for mild-moderate CDAD,which was significantly better than in severe cases(25.3%)or severe-complicated cases(35.5%)(P<0.001).There was no difference in demographics,hospitalization,ICU exposure,recurrence or 30-d mortality between adherent and non-adherent groups.A multivariate model revealed significantly decreased adherence for severe or severecomplicated episodes(OR=0.18,95%CI:0.11-0.30)and recurrent episodes(OR=0.46,95%CI:0.23-0.95).CONCLUSION:Overall adherence with the SHEA/IDSA guidelines for management of CDAD at a tertiary medical center was poor;this was most pronounced in severe,severe-complicated and recurrent *** interventions aimed at improving guideline adherence are warranted.

关键词： Clostridium difficile Metronidazole Vanco-mycin Adherence to the Infectious Diseases Society of America Guidelines Hospital Acquired Infections

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