790 - Evaluation of Connecticut Medical Providers Concordance with 2017 IDSA/SHEA Clostridioides difficile Treatment Guidelines in New Haven County, 2017-2019

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Presenting Author(s)

Casey M. Luc

Current PhD Student at UIC; YSPH MPH Graduate
Yale School of Public Health
NORTHBROOK, Illinois
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

DO

Danyel M. Olson

C. difficile Infection Project Coordinator
Connecticut Emerging Infections Program, Yale School of Public Health
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DB

David Banach

Associate Professor of Medicine, Hospital Epidemiologist
University of Connecticut School of Medicine, Yale School of Public Health
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JH

James Hadler

Senior Infectious Disease and Medical Epidemiology Consultant, Clinical Professor of Epidemiology
Connecticut Emerging Infections Program, Yale School of Public Health
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PC

Paula Clogher

Epidemiologist
Connecticut Emerging Infections Program
New Haven, Connecticut
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background:

Treatment guidelines for Clostridioides difficile infection (CDI) were updated by the Infectious Disease Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) in 2017, notably for disease severity and antibiotic recommendations. Our objectives were to assess Connecticut medical providers’ concordance (2017-2019) with the 2017 update. The effect of guideline concordance on the risk of CDI recurrence was also assessed.

Methods:

Using data from the Connecticut Emerging Infections Program’s CDI surveillance in New Haven County, severity and concordance were defined. For severity, white blood cell count and presence of megacolon and/or ileus were used. Concordant treatment was defined as receiving the recommended first-line antibiotic (vancomycin for adult patients, vancomycin or metronidazole for pediatric patients) for exactly 10 days. In univariate & multivariate analyses, significance was determined by a p-value of < 0.05.

Results:

Of 1,216 cases, concordance increased from 10.0% in 2017 to 36.9% in 2019. Concordance with first-line antibiotic increased from 40.2% in 2017 to 80.8% in 2019. Concordance was highest for fulminant cases (62.2%). The recurrence rate was 11.2% and highest for non-severe cases and older cases but was not significantly associated with concordance.

Concordance with selected treatment criteria by year, 2017-2019

Conclusion:

From 2017 through 2019, CDI treatment in New Haven County increasingly was concordant with the updated 2017 IDSA/SHEA guidelines, but still low overall in 2019. Although concordance with treatment did not affect recurrence risk, close attention should be paid by medical providers to non-severe cases and older cases as they are at an increased risk for recurrence.