2347. Impact of Multidisciplinary Review of Clostridioides difficile Testing

BACKGROUND: Minimizing Clostridioides difficile infections (CDI) is an important patient safety goal due to significant cost and disease burden with CDI causing 15,000 deaths annually in the United States. Diagnosis of CDI is complicated when DNA amplification assay will return positive for both colonization and active infection of C. difficile, so testing clinically symptomatic patients with at least 3 loose stools per day is paramount to obtaining accurate reporting rates and starting proper treatment for CDI. METHODS: Due to economic considerations, the study was a single-center retrospective review of inpatients ≥ 18 years old who had C. difficile tests ordered from November 2017 to February 2019. Baseline characteristics collected include age, sex, white blood cell (WBC) count, fever, past C. difficile infections, recent antibiotic use, recent laxative use, and tube feeding status. Data were analyzed using descriptive statistics. The primary objective of this study was to look at the appropriateness of C. difficile tests pre and post-implementation of multidisciplinary review. Criteria for appropriateness of testing included 3 or more loose stools in addition to one additional factor including fever, elevated WBCs, immunocompromised status, or severe sepsis/septic shock. Secondary objectives include evaluating hospital-onset CDI rates and cost analysis. RESULTS: Baseline characteristics were similar between the two groups with the exception of statistically fewer patients with 3 or more liquid stools found in the post-implementation group (P = 0.0003). After implementation of a multidisciplinary review, the number of C. difficile tests ran significantly declined from 79% to 56% (P = 0.0001). The number of negative tests also were significantly reduced from 60% to 43% (P = 0.0001), with patients who had less than 3 stools per day being tested less frequently in the post-implementation group. Inappropriate test avoidance resulted in an annual savings of $1,550 in testing supplies alone, not including isolation or labor costs. There was no significant difference in hospital-onset CDI. CONCLUSION: Implementation of a multidisciplinary review of C. difficile testing avoids clinically inappropriate tests and results in cost savings with no effect on incidence of hospital-onset CDI. DISCLOSURES: All authors: No reported disclosures.