1889. A Clinical Practice Assessment on Clostridium difficile Infection

BACKGROUND: This study assessed physicians’ current practice patterns in prevention and management of Clostridium difficile infection (CDI). METHODS: A 25-question clinical practice assessment survey was made available to infectious disease (ID) specialists without monetary compensation or charge. Questions evaluated knowledge, competence, and barriers related to CDI, such as current and emerging strategies for limiting risk and achieving optimal outcomes related to antimicrobial use. The survey launched on a website dedicated to continuous professional development on October 27, 2017. Data were collected until January 16, 2018. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. RESULTS: 139 ID specialist physicians completed the survey during the study period. Key findings include: (a) 76% were not aware of CDI incidence in the United States. (b) 34% had 20 or more cases of CDI in their practice in the past year. (c) While only 7% admitted their institution had been penalized for CDI under value-based purchasing rules, 50% were unsure. (d) While 96% were correctly able to identify antibiotics most closely associated with development of CDI, only 22% reported they were very confident in recognizing host risk factors for CDI, and 64% were not aware of the risks of CDI-associated death in older patients vs. middle-aged patients. (e) 38% use PCR for CDI diagnosis; 36% use a 2-step method combining different test types. (f) 39% were not aware of the relationship of the gut microbiome and CDI, although 61% reported that they would initiate an FDA-approved agent aimed at protecting the gut microbiome from antibiotic-mediated dysbiosis. (g) About 33% were not aware of new strategies being investigated for prevention of CDI and their mechanisms of action. (h) 94% reported that achieving optimal clinical outcomes and reducing selection for antimicrobial-resistance were the most important goals of antimicrobial stewardship. CONCLUSION: This research yielded important insights into current clinical practice gaps among ID specialists regarding identification and prevention of CDI, and could serve to inform needs for continuing medical education. DISCLOSURES: D. Mathews, Synthetic Biologics: Employee, Salary. T. Delk, Synthetic Biologics: Employee, Salary.