Clinical Impact of Implementing a Specific Clinical Pathway for the Management of Clostridioides difficile Infection

IntroductionDespite Clostridioides difficile infection (CDI) being a leading healthcare-associated infection with high morbimortality, there is little evidence on specific antimicrobial stewardship program (ASP) interventions for CDI. The objective of this study was to assess the clinical impact of...

Descripción completa

Detalles Bibliográficos
Autores: Rodríguez-Fernández, M, Herrero, R, González-De-La-Aleja, P, Valverde-Fredet, MD, Ventero, MP, Trigo-Rodríguez, M, Giner, L, Aller-García, AI, Pinargote-Celorio, H, Espíndola-Gómez, R, Parra, M, Pérez-Crespo, PM, Ramos-Rincón, JM, Fernández-Pevida, A, Lanz-García, J, León, E, Valiente-De-Santis, L, Corzo, JE, Rodríguez, JC, Merino, E, Merchante, N
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Instituto de Investigación Biomédica y Sanitaria de Alicante (ISABIAL)
Repositorio:r-ISABIAL. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica y Sanitaria de Alicante
OAI Identifier:oai:dnet:isabial_____::78047b0744b8f37aa54338cc595666cb
Acceso en línea:https://isabial.portalinvestigacion.com/publicaciones12478
https://link.springer.com/article/10.1007/s40121-025-01261-9?utm_source=getftr&utm_medium=getftr&utm_campaign=getftr_pilot&getft_integrator=clarivate
Access Level:acceso abierto
Palabra clave:<italic>Clostridioides difficile</italic>
Clinical pathway
Recurrence
Hospital admission
Mortality
Health plan implementation
Descripción
Sumario:IntroductionDespite Clostridioides difficile infection (CDI) being a leading healthcare-associated infection with high morbimortality, there is little evidence on specific antimicrobial stewardship program (ASP) interventions for CDI. The objective of this study was to assess the clinical impact of implementing a specific clinical pathway for CDI management at two Spanish hospitals.MethodsThis was a quasi-experimental pre-post intervention study, and three periods were evaluated: historical (2014-2017), educational-ASP (2018-2020), and intervention (2021-2023), after implementation of a CDI-specific measures bundle. Key measures included: (1) updated local CDI guidelines; (2) 24/7 diagnostic testing and real-time positive results notification to ASP-CDI team; (3) systematic evaluation of new cases; (4) optimizing CDI antibiotic treatment and overall management; and (5) structured follow-up until 8 weeks post-treatment. Primary outcome was first CDI recurrence, and secondary outcomes were readmissions during recurrent CDI episodes and 30-day all-cause mortality.ResultsIn total, there were 1435 patients with CDI included: 370 in the historical period (2014-2017), 537 in the educational-ASP period (2018-2020), and 528 in the CDI-specific clinical pathway period (2021-2023). First CDI recurrence rates significantly declined across periods in high-risk groups: immunocompromised patients, 29% in 2014-2017, 22% in 2018-2020, and 15% in 2021-2023 (p = 0.038); those with severe/fulminant initial CDI, from 38% to 34% to 24% (p = 0.027); and patients aged 65-79 years, from 29% to 31% to 13% (p = 0.003). Hospitalization during recurrent CDI episodes and mortality were significantly reduced in the CDI-specific clinical pathway period: readmissions, 11% (2014-2017), 13% (2018-2020), and 6% (2021-2023) (p = 0.017); mortality, 7%, 6%, and 4% (p = 0.023).ConclusionsThe implementation of a structured, multifaceted clinical pathway specifically designed for CDI management had significant clinical benefits, including a reduction of recurrences in high-risk groups, readmissions, and mortality.Trial RegistrationClinicalTrials.gov identifier NCT04801862.

Similares en LA Referencia