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1. Impact of a division-wide bundle on hospitalacquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs

Author

Elizabeth Wenqian Wang, Ashlee Weekley, Jennifer McCarty, Hoonmo Koo, Bradley Lembcke, and Mayar Al Mohajer

Subjects
c. difficile, cost, diagnostic stewardship, dot, testing, Medicine
Abstract

Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.

Published
2021
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2. Impact of a division-wide bundle on hospital-acquired Clostridioides difficile cases, antibiotic days of therapy, testing appropriateness, and associated financial costs

Author

Elizabeth Wenqian Wang, Ashlee Weekley, Bradley Lembcke, Jennifer McCarty, Hoonmo Koo, and Mayar Al Mohajer

Subjects
Financial costs, medicine.medical_specialty, medicine.drug_class, business.industry, DOT, Antibiotics, 030204 cardiovascular system & hematology, Clostridium difficile, C difficile, testing, Cost savings, 03 medical and health sciences, 0302 clinical medicine, Bundle, Internal medicine, cost, medicine, diagnostic stewardship, Medicine, Original Article, 030212 general & internal medicine, C. difficile, business, Clostridioides
Abstract

Introduction: Updated international guidelines recommend the use of a two-step algorithm (glutamate dehydrogenase [GDH] or nucleic-acid amplification test [NAAT] plus toxin) rather than NAAT alone for the diagnosis of Clostridioides difficile (formerly Clostridium difficile) infections. The goal of our project was to evaluate the impact of a new bundle on the rate of hospital-acquired C. difficile infections (CDIs), hospital-acquired CDI standardized infection ratio (SIR), antibiotic days of therapy (DOT), and financial cost. Materials and Methods: The new bundle was implemented in April 2018. This bundle was implemented across five hospitals in Catholic Health Initiatives (CHI) Texas Division. The bundle included a switch from NAAT to a two-step process (GDH and toxin). We placed the new test in an order panel which included enteric isolation and required indications for C. difficile testing. We used quarterly data pre- and post-intervention to calculate SIR and DOT. Results: In the pre-intervention period, 15.5% of the total 3513 C. difficile NAAT was positive. In the post-intervention period, 5.7% of a total of 2845 GDH and toxin assays was positive for both GDH and toxin (P < 0.0001). SIR, which adjusts for denominator and change in testing methodology, also dropped from 1.02 to 0.43. The estimated cost associated with positive C. difficile cases dropped from 1,932,150 USD to 1,113,800 USD with an estimated yearly cost saving of 794,150 USD. Compliance with enteric isolation improved from 73.1% to 92.5% (P = 0.008). Conclusion: The new testing bundle led to a marked reduction in hospital-acquired CDI and unnecessary treatment, reduction in C. difficile testing, an increase in compliance with enteric isolation, and significant cost savings.

Published
2021

3. Infectious Diseases

Author

Zeimet, Anthony, McBride, David R., Basilan, Richard, Roland, William E., McCrary, David, and Hoonmo, Koo

Subjects
Article
Published
2020

4. Infectious Diseases

Author

Zeimet, Anthony, primary, McBride, David R., additional, Basilan, Richard, additional, Roland, William E., additional, McCrary, David, additional, and Hoonmo, Koo, additional

Published
2011
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5. Contributors

Author

Syed M. Ahmed, Irene Alexandraki, Louis F. Amorosa, Gregory J. Anderson, Roberto A. Andrade, Bruce Bagley, Bruce Barrett, Richard Basilan, J. Mark Beard, Wendy S. Biggs, Harold Bland, John F. Bober, David A. Brechtelsbauer, Jason N. Buchanan, Jennifer J. Buescher, Kara Cadwallader, William E. Carroll, Charles Carter, Douglas Comeau, Renee Crichlow, Earl R. Crouch, Eric R. Crouch, Alan K. David, Frank Verloin DeGruy, Eric J. Dippel, Jonathan A. Drezner, Denise M. Dupras, Bernard Ewigman, W. Gregory Feero, Robert E. Feinstein, Blair Foreman, Gregory M. Garrison, Curtis Gingrich, Andrea Gordon, Thomas R. Grant, Mary P. Guerrera, Janelle Guirguis-Blake, Kimberly G. Harmon, Kevin Heaton, Joel J. Heidelbaugh, Donald D. Hensrud, Vivian Hernandez-Trujillo, Arthur H. Herold, Paul J. Hershberger, Robert Holleman, Keith B. Holten, Jodi Summers Holtrop, Thomas Houston, Mark R. Hutchinson, Wayne Jonas, Robert B. Kelly, Sanford R. Kimmel, Hoonmo Koo, Colin P. Kopes-Kerr, Alicia Kowalhuk, Jennifer Krejci-Manwaring, Esther J. Lee, Jeanne P. Lemkau, Phil Lieberman, Adriana C. Linares, David R. McBride, David McCrary, Stephen P. Merry, David Meyers, Gregg Mitchell, James L. Moeller, Arshag Mooradian, Scott E. Moser, Mary Barth Noel, John G. O'Handley, John W. O'Kane, Justin Osborn, Heather L. Paladine, Minal Patel, Gabriella Pridjian, David P. Rakel, Robert E. Rakel, Terry G. Rascoe, Karen Ratliff-Schaub, Brian C. Reed, Michael D. Reis, J. Adam Rindfleisch, R. Hal Ritter, William E. Roland, Brian Rothberg, George Rust, Zishan Samiuddin, Gorge Samraj, Christopher D. Schneck, Sarina B. Schrager, Ann I. Schutt-Ainé, Stacy Seikel, Ashish R. Shah, Krupa Shah, Nicolas W. Shammas, Kevin M. Sherin, Jeffrey A. Silverstein, Alan J. Smith, David A. Smith, Douglas R. Smucker, Abby Snavely, James Stallworth, Nancy G. Stevens, Melissa Stiles, Elizabeth M. Strauch, Jeff Susman, David Swee, Margaret Thompson, Evan J. Tobin, Peter P. Toth, Richard P. Usatine, William C. Wadland, Steven Waldren, Kathleen Walsh, Elizabeth A. Warner, Gloria Westney, Russell D. White, Dave E. Williams, George Wilson, Jane E. Wilson, Tracy Wolff, Philip Zazove, and Anthony Zeimet

Published
2011

6. Coliform and Escherichia coli contamination of desserts served in public restaurants from Guadalajara, Mexico, and Houston, Texas

Author

Karen J, Vigil, Zhi-Dong, Jiang, Jaclyn J, Chen, Kathryn L, Palumbo, Thushara, Galbadage, Eric L, Brown, Jing, Yiang, Hoonmo, Koo, Margaret W, DuPont, Charles, Ericsson, Javier A, Adachi, and Herbert L, DuPont

Subjects
Restaurants, Enterobacteriaceae, Ice Cream, Escherichia coli, Food Microbiology, Mexico, Texas
Abstract

Bacterial enteropathogens acquired from contaminated food are the principal causes of travelers' diarrhea (TD). We evaluated desserts obtained from popular restaurants in the tourist city of Guadalajara, Mexico, and Houston, Texas, to determine coliform and Escherichia coli contamination levels and presence of diarrheagenic E. coli known to be important in TD. Contamination for all organisms was seen for desserts served in Guadalajara restaurants. Desserts should be considered as potentially risky foods for development of TD among international visitors to developing regions of the world.

Published
2009

8. Enteroaggregative Escherichia coli: A Review of Trends, Diagnosis, and Treatment.

Author

Cennimo, David J., Hoonmo Koo, Mohamed, Jamal A., Huang, David B., and Tom Chiang

Abstract

The article provides an overview of the trends, diagnosis and treatment of enteroaggregative Escherichia coli (EAEC). It mentions the 6 recognized pathotypes of diarrheagenic Escherichia coli. Also, it notes that genetics plays an important role in determining the host's susceptibility to diarrheal illness, and one of the most common clinical manifestations of EAEC infection is watery diarrhea, usually unaccompanied by blood or mucus.

Published
2007

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