Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics.

OBJECTIVE: To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs). DESIGN: We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE). SETTING: Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution. METHODS: In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis. RESULTS: An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups (P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months (P < .001) and all ages combined (P = .003). CONCLUSION: Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.

A comparison of the incidence of midline catheter-associated bloodstream infections to that of central line-associated bloodstream infections in 5 acute care hospitals.

In a retrospective study conducted over 12 months in a multi-hospital system, the incidence of bloodstream infections associated with midline catheters was not significantly lower than that associated with central venous catheters (0.88 vs 1.10 infections per 1,000 catheter-days). Additional research is needed to further characterize the infectious risks of midline catheters and to determine optimal strategies to minimize these risks.

Electronic surveillance for catheter-associated urinary tract infections at a university-affiliated children's hospital.

We sought to describe the characteristics of catheter-associated urinary tract infections (CAUTIs) in a children's hospital while demonstrating efficacy of electronic identification of CAUTIs. There were 25 CAUTIs identified over 24 months, with most (88%) occurring in the intensive care units (ICUs). The incidence of ICU CAUTIs decreased during the study period (P = .04). Concordance between electronic identification and validation by infection control staff was 83% and increased to 100% with correction of nursing documentation.