By David Wild
Root cause analysis (RCA) is an important strategy for improving antibiotic use and reducing the risk for hospital-acquired Clostridioides difficile infection (CDI), according to researchers at the Duke Center for Antimicrobial Stewardship and Infection Prevention, in Durham, N.C.
“Mini–root cause analyses can identify high-yield opportunities for CDI risk reduction,” according to Nicholas Turner, MD, an assistant professor of medicine at Duke University School of Medicine, also in Durham, and his colleagues.
To document how this analytical tool can be used to evaluate the appropriateness of CDI testing and inpatient antibiotic use, Dr. Turner and his team conducted RCAs for 608 patients diagnosed with hospital-onset CDI at 20 hospitals in the Southeast region of the United States.
The findings presented at IDWeek 2020 showed that 45% of these patients underwent inappropriate testing for C. difficile, most commonly because they had been receiving laxatives, did not have diarrhea or abdominal pain, or were undergoing tube feeding (poster 799).
The researchers also found inappropriate prescribing patterns for the 1,783 antibiotic orders written for these patients during the 30 days preceding these CDI diagnoses. The most frequent problems with prescribing were ordering the wrong duration or indication and using the incorrect spectrum of antibiotic agent for urinary tract infections, pneumonia and abdominal infections. Some prophylactic orders were given for the wrong duration, while some agents ordered for osteomyelitis, endocarditis, and skin and soft tissue infections were for the incorrect spectrum of antibiotic.
Late-generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, carbapenems, monobactams and fluoroquinolones were the agents most commonly used inappropriately. In contrast, the researchers noted that early-generation cephalosporins, gram-positive agents and macrolides were most likely to be used appropriately.