N8. Clostridium difficile
Oral Abstract Submission
Background : Clostridium Difficile Infections (CDI) cause approximately 500,000 cases a year with an estimated cost that exceeds $4.8 billion. Despite interventions that addressed environmental disinfection, antibiotic stewardship and Infection control, many institutions continue to have significant burden of disease. Public reporting and "pay for performance" have increased the impetus for better control of CDI. We describe the use of a unpublished scoring system to assess risk of CDI with subsequent use of OVP to prevent exsporulation and infection in high risk groups.
Methods : A large urban hospital in Chicago area of approx. 400 beds, after following recommended guidelines for prevention of C. difficile, instituted an assessment tool to predict risk of developing C. difficile infection.This is an observational, cohort study reviewing the pre and post implementation of OVP (Oral Vancomycin prophylaxis) in hospitalized patients. From 1/2017 thru 12/2017, eligible patients were assessed for risk of C. difficile. The intervention period, from 1/2018 thru 12/2018, we prospectively gave eligible patients oral vancomycin (OVP) 125 mg twice daily if risk score was 13 or above. No changes in environmental cleaning, antimicrobial stewardship or restriction of testing were instituted during the periods of enrollment. The analysis was approved by the IRB.
In 2017, 82 patients had a score of 13 or over. 72/82 (87.8%) developed CDI. In 2018, 62 eligible patients had a score of 13 or over and were given OVP. 5/62 (8%) developed CDI. The relative risk comparing C.diff in >/=13 versus < 13 patients (RR=19.2652; 95% CI= 7.3656, 50.3899). The tool is associated with a specificity of 88.54% and sensitivity of 94.67%, along with a negative predictive value= 95.51% and positive predictive value=86.59%. Fisher's exact test was performed between OVP and no OVP in relation to the development of CDI in high risk patients (P < 0.01). VRE rates reported on the antibiogram remained consistent throughout the study period. No significant differences in baseline characteristics were noted.
Conclusion : In institutions where appropriate infection control measures and antibiotic stewardship have been implemented, the use of a prediction tool to guide OVP is effective in preventing C. difficile.