Impact of Evidence Based Guidelines for Management of Clostridium Difficile Infection [abstract]

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Abstract from the 2015 ACCP Virtual Poster Symposium, May 18-19:

OBJECTIVES: To determine the impact of an evidence-based guideline established for the treatment of Clostridium difficile infection (CDI) at a community teaching hospital. Endpoints included length of stay (LOS) after diagnosis, mortality, direct cost, and 30-day readmission rates.

METHODS: Relevant literature was reviewed by internal medicine physicians, residents, and pharmacists to develop an internal treatment guideline for the classification and management of CDI. The guideline follows the Infectious Disease Society of America/ Society for Healthcare Epidemiology of America 2010 recommendations. The hospital guideline was provided to physicians and medical residents via email, an internal website, a resident pharmacotherapy handbook, and as a formal presentation during a noon conference. A retrospective chart review was conducted to identify LOS, mortality, direct cost, and readmission rates, as well identify physician adherence to the guideline provided.

RESULTS: Seventy-nine patients were evaluated and it was found that guideline-based therapy (n = 31) was associated with a shorter LOS (7.45 days vs 7.9 days), decreased mortality (3.2% vs 6.3%), and a reduction in 30-day hospital readmission (29% vs 38%). However, guideline-based therapy was associated with a mean higher cost ($17,141 vs $12,787). None of these results achieved statistical significance. Although education was provided and access to the guideline was readily available, adherence by physicians and residents to the guideline-based therapy only occurred in 45% of patients.

CONCLUSIONS: Implementation of guideline-based therapy for CDI may result in a reduction in LOS, 30-day hospital readmission, and mortality. Surprisingly a reduction in cost was not noted in the guideline-based therapy. Barriers to physician adherence still seem to exist despite seemingly adequate education and availability of the guidelines. Perhaps periodically revisiting education and adding requirements for ordering medications could improve adherence. Additionally, higher adherence rates may provide more definitive data for potential significance


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