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4CPS-248 Appropriateness of the Clostridium difficile infection prescription prior to the implementation of a protocol for its management
  1. JM Vinuesa Hernando1,
  2. V Acín Garcés2,
  3. R Gracia Piquer1,
  4. R Fresquet Molina1,
  5. E Morte Romea3,
  6. M Gimeno1,
  7. C Seral García4,
  8. M Arenere Mendoza1
  1. 1Hospital Clínico Universitario Lozano Blesa, Pharmacy, Zaragoza, Spain
  2. 2Universidad De Zaragoza, Medicine Faculty, Zaragoza, Spain
  3. 3Hospital Clínico Universitario Lozano Blesa, Infectious Diseases, Zaragoza, Spain
  4. 4Hospital Clínico Universitario Lozano Blesa, Microbiology, Zaragoza, Spain


Background and importance Clostridium difficile disease (CDD) is the main cause of nosocomial diarrhoea.

Aim and objectives To evaluate the adequacy of treatment of CDD prior to implementation of the checklist for the diagnosis and treatment of CDD.

Material and methods This was a retrospective observational study of CDD cases in a tertiary hospital during 2019. The adequacy of treatment of positive cases was evaluated according to the checklist, considering variables for vulnerability (cancer patients, neutropenic, transplant recipients, inflammatory bowel disease or prolonged antibiotic treatment), severity (according to leucocytosis, renal function or presence of hypotension, shock or ileus), risk of recurrence (age, CDD the previous year, positive toxin or persistence of diarrhoea on the fifth day) and their treatment.

Results There were 126 cases of CDD in 100 patients, with a median age of 76 years (1–96) and 59% were women. The adequacy of the protocol was checked in 103 cases and the rest were incomplete:

  • First non–severe episode/non–vulnerable patient (protocol: metronidazole → vancomycin): one case was not appropriate because it was treated with fidaxomycin before vancomycin.

  • First non–severe episode/vulnerable patient (protocol: vancomycin → fidaxomycin): five cases were not adequate because they were not treated with vancomycin initially.

  • First severe episode/non–vulnerable patient (protocol: vancomycin → fidaxomycin): seven cases were not appropriate because they were not treated with vancomycin initially.

  • First severe episode/vulnerable patient (protocol: vancomycin → fidaxomycin → vancomycin+bezlotoxumab): one was not adequate because they were not treated with vancomycin initially.

  • Fulminant (protocol: vancomycin+metronidazole IV): two cases were not appropriate as they were not initially treated with vancomycin+metronidazole IV.

  • First episode and mild recurrence (protocol: vancomycin): six cases were not adequate. All should have been treated initially with vancomycin.

  • First severe episode or recurrence (protocol: vancomycin or fidaxomycin±bezlotoxumab, depending on previous treatment): in four cases the treatment received was not appropriate because vancomycin is not indicated without continuing a downward pattern.

The treatment received was not appropriate in 26 (25.2%) cases.

Conclusion and relevance The percentage of patients whose treatment did not follow the protocol was considerable (26.5%). An increase in protocol deviations was observed in more complex treatments as the severity and/or vulnerability of the patient increased. Although oral metronidazole should be reserved only for the first mild episode in non-vulnerable patients, overuse was observed in all cases.

References and/or acknowledgements


Conflict of interest No conflict of interest

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