Reducing delays in the diagnosis and treatment of Clostridium difficile diarrhoea

Background: The diagnosis of Clostridium difficile diarrhoea is often delayed. Aim: To assess and reduce delays in diagnosis and treatment Design: Two-part study: retrospective audit then prospective observational. Methods: The retrospective study audited cases positive for C. difficile culture or toxin A between June 2000 and January 2001. Cases were reviewed regarding demographic characteristics and the timing from onset of symptoms to testing and treatment (n = 27). In the prospective study, efforts were made to increase the awareness of medical staff about C. difficile diarrhoea, and testing for C. difficile toxin A assay was substituted for stool culture and external toxin analysis. Data were prospectively analysed for demographic characteristics and time from onset of symptoms to testing and treatment (n = 24). Results: There were no significant differences in age (76 vs. 78 years), male to female ratio (1:2 vs. 1:4), reason for admission, specialty responsible, or mortality rate (40% vs. 37%) during the presenting admission. Preceding antibiotic use, the combination of antibiotics used and subsequent treatment also did not differ between groups. The time from onset of diarrhoea to sampling was reduced from 4.7 days (range 3-30) to 0.8 days (range 0-5; p less than or equal to 0.05). The time from sampling to treatment was reduced from 7.7 days (5-34) to 2.8 days (2-9; p less than or equal to 0.05). Discussion: The combination of increased awareness of C. difficile diarrhoea and the change to in-house toxin testing significantly reduced the time from onset of symptoms to sampling and treatment.