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Impact of a Multi-disciplinary C. difficile Action Team

BACKGROUND: Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essentia...

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Autores principales: Heil, Emily, Sivasailam, Bharathi, Park, SoEun, Diaz, Jose, Von Rosenvinge, Erik, Claeys, Kimberly, Hopkins, Teri, Leekha, Surbhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631311/
http://dx.doi.org/10.1093/ofid/ofx163.989
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author Heil, Emily
Sivasailam, Bharathi
Park, SoEun
Diaz, Jose
Von Rosenvinge, Erik
Claeys, Kimberly
Hopkins, Teri
Leekha, Surbhi
author_facet Heil, Emily
Sivasailam, Bharathi
Park, SoEun
Diaz, Jose
Von Rosenvinge, Erik
Claeys, Kimberly
Hopkins, Teri
Leekha, Surbhi
author_sort Heil, Emily
collection PubMed
description BACKGROUND: Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. METHODS: A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. RESULTS: We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. CONCLUSION: Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-56313112017-11-07 Impact of a Multi-disciplinary C. difficile Action Team Heil, Emily Sivasailam, Bharathi Park, SoEun Diaz, Jose Von Rosenvinge, Erik Claeys, Kimberly Hopkins, Teri Leekha, Surbhi Open Forum Infect Dis Abstracts BACKGROUND: Clostridium difficile infection (CDI) is associated with increased length of hospital stay, morbidity, mortality, and cost of hospitalization. Early intervention by experts from multiple areas of practice such as gastroenterology (GI), infectious diseases (ID) and surgery can be essential to optimize care and increase utilization of novel treatment modalities such as fecal microbiota transplant (FMT) and minimally invasive, colon-preserving surgical management. METHODS: A multi-disciplinary C. difficile action team (MD-CAT) was implemented at University of Maryland Medical Center (UMMC) in March 2016 to engage appropriate specialty consultants in the care of CDI patients. The MD-CAT reviews positive C. difficile tests at UMMC and provides guidance and suggestions to the primary team including optimal antibiotic treatment (for CDI and any concomitant infection), and consultant involvement including ID, surgery, and GI, when appropriate. Using retrospective chart review, CDI patient management and outcomes were compared before and after implementation of the MD-CAT. Differences in the time to consults and frequency of interventional treatment was compared using Chi-square or Wilcoxon Rank-sum test. RESULTS: We compared 48 patients with CDI in the pre-intervention with 89 patients in the post-intervention period. Demographic and clinical characteristics of the groups were similar. MD-CAT intervention was associated with frequent (73%) modification or discontinuation of concomitant antibiotics. Median time to GI and ID consults was significantly shorter in the post group (P = 0.007 and P = 0.004, respectively). Five of 89 (5.6%) of patients received FMT or colon-preserving surgical intervention in the post-intervention group compared with no patients in the pre-intervention group. There was no difference in 30-day all-cause mortality or CDI recurrence between groups. CONCLUSION: Early, multi-disciplinary action on patients with CDI increased the proportion of patients undergoing active specialty consultation and improved use of concomitant antibiotics. A larger sample size is needed to determine the effects of such a team on other clinical outcomes. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2017-10-04 /pmc/articles/PMC5631311/ http://dx.doi.org/10.1093/ofid/ofx163.989 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Heil, Emily
Sivasailam, Bharathi
Park, SoEun
Diaz, Jose
Von Rosenvinge, Erik
Claeys, Kimberly
Hopkins, Teri
Leekha, Surbhi
Impact of a Multi-disciplinary C. difficile Action Team
title Impact of a Multi-disciplinary C. difficile Action Team
title_full Impact of a Multi-disciplinary C. difficile Action Team
title_fullStr Impact of a Multi-disciplinary C. difficile Action Team
title_full_unstemmed Impact of a Multi-disciplinary C. difficile Action Team
title_short Impact of a Multi-disciplinary C. difficile Action Team
title_sort impact of a multi-disciplinary c. difficile action team
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631311/
http://dx.doi.org/10.1093/ofid/ofx163.989
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