Prospective Review of Clostridioides difficile Testing Indications to Inform Local Laboratory Stewardship Initiatives

Noah Reich; Michael Payne; Azra Sharma; Sylvie Champagne; Marc G Romney; Michelle Hinch; Victor Leung; Christopher F Lowe

doi:10.1016/j.infpip.2019.100017

Prospective Review of Clostridioides difficile Testing Indications to Inform Local Laboratory Stewardship Initiatives

Infect Prev Pract. 2019 Aug 5;1(2):100017. doi: 10.1016/j.infpip.2019.100017. eCollection 2019 Jun.

Authors

Noah Reich¹, Michael Payne^{1

2

3}, Azra Sharma³, Sylvie Champagne^{1

2}, Marc G Romney^{1

2}, Michelle Hinch⁴, Victor Leung^{1

2

3

4}, Christopher F Lowe^{1

2

3}

Affiliations

¹ Faculty of Medicine, University of British Columbia, Canada.
² Division of Medical Microbiology, St. Paul's Hospital, Vancouver, BC, Canada.
³ Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
⁴ Antimicrobial Stewardship Program, Providence Health Care, Vancouver, BC, Canada.

Abstract

We conducted a prospective chart review to determine the prevalence of and reasons for inappropriate Clostridioides difficile test-ordering at a tertiary care hospital. Inappropriate orders accounted for 54% of all tests. The two primary aetiologies of inappropriate test-ordering were an alternative reason for diarrhoea (34%) and an asymptomatic patient (20%). These results highlight the need to focus diagnostic stewardship of C. difficile testing on pre-analytical factors.

Keywords: Clostridioides difficile; Diagnostic Stewardship; Infections; Laxative; Pre-analytical.