Abstract Corresponding Author Susan McGrath, BS, MT (ASCP), CIC, Director, Department of Infection Prevention, Children’s Specialized Hospital, 200 Somerset Street, New Brunswick, NJ 08901, USA, (732) 258-7171, smcgrath@childrens-specialized.org Funding None received. Conflict(s) of Interest Susan M., no conflict; Karen K. Same, no conflict; Colin O. Same, no conflict; Kelly KM. Same, no conflict; Christine T. Same, no conflict. Background In February 2019, children residing in our long-term care facility who may be medically fragile or have complex medical needs experienced diarrhea and were tested to rule out C. difficile infection. During this outbreak, 9 children tested positive for C. difficile which led to enteric contact isolation and antimicrobial treatment. Norovirus was subsequently identified in four of the children. Was C. difficile or Norovirus the causative agent of the acute gastrointestinal outbreak? A review of evidence-based practices showed high C. difficile colonization rates in children under 2 years of age and that other causes such as viral pathogens or change in medications should be considered before testing for C. difficile. This realization led us to reassess our testing protocols to ensure that diagnostic practices align with clinical guidelines and truly benefit patient care. Most testing guidelines were indicated for acute care visits in which recent hospitalization was an indication to test for C. difficile, which is not appropriate for post-acute care. Methods Timeframe for data collection was January 2021 through December 2024. Testing parameters include the child’s age and consideration for other causes of diarrhea. Orders for C. difficile were reviewed for compliance with the algorithm and real time feedback was provided to medical providers when non-compliance was identified. Results The results of this study show an increase in compliance with the algorithm and indicate a reduction in the use of Vancomycin or Metronidazole for patients with diarrhea from 2021 to 2024. The rate of C. difficile decreased from 3.2 cases per 10 000 patient days in 2021 to 0.2 cases per 10 000 patient days in 2024. In 2021 when the study started, 23 children received antibiotics for diarrhea, 21 orders for C. difficile and 71% compliance with all parameters of the algorithm. In 2024 7 children received antibiotics for diarrhea, 7 orders for C. difficile and 86% compliance with all parameters of the algorithm. This corresponded to a 70% decrease in antimicrobial use. Conclusion The use of a testing algorithm improved patient care by reducing C. difficile rates and optimizing antimicrobial stewardship by minimizing unnecessary antibiotic use. This dual impact reinforces the importance of targeted interventions in managing infections and promoting safer, more responsible antibiotic practices within healthcare settings. Next steps include:
McGrath et al. (Mon,) studied this question.