Transplantation Proceedings2022，Vol.54Issue(3) ：5.DOI:10.1016/j.transproceed.2021.10.034

Antibiotic Stewardship and Inpatient Clostridioides difficile Testing in Solid Organ Transplant Recipients: The Need for Multilevel Checks and Balances

Kueht, Michael Kharsa, Ahmad Mujtaba, Muhammad Kulkarni, Rupak Britt, Rachel Lea, A. Scott Hafiz, Ghani Fair, Jeffery Reynoso, David
Transplantation Proceedings2022，Vol.54Issue(3) ：5.DOI:10.1016/j.transproceed.2021.10.034
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  • NSTL
  • Elsevier

Antibiotic Stewardship and Inpatient Clostridioides difficile Testing in Solid Organ Transplant Recipients: The Need for Multilevel Checks and Balances

Kueht, Michael 1Kharsa, Ahmad 2Mujtaba, Muhammad 3Kulkarni, Rupak 1Britt, Rachel 4Lea, A. Scott 5Hafiz, Ghani 1Fair, Jeffery 1Reynoso, David5
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作者信息

  • 1. University of Texas System,Univ Texas Med Branch
  • 2. Sch Med,Univ Texas Med Branch
  • 3. Dept Med,Univ Texas Med Branch
  • 4. Dept Pharm,Univ Texas Med Branch
  • 5. Dept Infect Dis,Univ Texas Med Branch
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Abstract

Background. Diarrhea among recipients of solid organ transplants is a commonly encountered problem and is often multifactorial in etiology. Owing to the combination of perioperative antibiotic administration and the immunosuppressed status of transplant recipients, a high degree of suspicion for Clostridioides difficile (C. difficile) colitis is prudent. The purpose of this study is to demonstrate the association of an institutional integrated stewardship program with C. difficile testing practices after abdominal solid organ transplantation. Methods. Starting in July 2017, a diagnostic stewardship was enacted in our institution requiring the ordering provider to answer a series of questions within the electronic medical record before ordering a C. difficile toxin test. The charts were reviewed for all solid organ transplant recipients on whom a test was ordered between January 2016 and September 2019. Results. Orders for C. difficile toxin per quarter significantly decreased in the postintervention era (18 vs 8.5, P = .038). Median cost of inpatient treatment and days of therapy per thousand patient days was significantly lower in the postintervention era (median cost, $2,944.55 vs $416.92; P = .01) (days of therapy per thousand patient days, 521.9 vs 300.5; P < .01). Quarterly rates of negative tests were similar between the pre- and postintervention eras (65% vs 73%, P = .38). Conclusions. Although no orders were blocked based on the responses, this multilevel intervention was associated with a 47% decrease in C. difficile testing without effecting the rate of negative testing. These results suggest that we have achieved significant cost savings, in testing and isolation, without sacrificing critical aspects of clinical care.

Key words

INFECTION

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出版年

2022
Transplantation Proceedings

Transplantation Proceedings

ISTP
ISSN：0041-1345
被引量5
参考文献量12
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