{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T16:40:23Z","timestamp":1770914423940,"version":"3.50.1"},"reference-count":15,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T00:00:00Z","timestamp":1655251200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X22001179_as1\"><jats:title>Objective:<\/jats:title><jats:p>To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) <jats:italic>Clostridioides difficile<\/jats:italic> infections (CDIs).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001179_as2\"><jats:title>Design:<\/jats:title><jats:p>We performed a retrospective analysis of <jats:italic>C. difficile<\/jats:italic> testing from hospitalized children before (October 2017\u2013October 2018) and after (November 2018\u2013October 2020) implementing restrictive computerized provider order entry (CPOE).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001179_as3\"><jats:title>Setting:<\/jats:title><jats:p>Study sites included hospital A (a \u223c250-bed freestanding children\u2019s hospital) and hospital B (a \u223c100-bed children\u2019s hospital within a larger hospital) that are part of the same multicampus institution.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001179_as4\"><jats:title>Methods:<\/jats:title><jats:p>In October 2018, we implemented CPOE. No testing was allowed for infants aged \u226412 months, approval of the infectious disease team was required to test children aged 13\u201323 months, and pathology residents\u2019 approval was required to test all patients aged \u226524 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney <jats:italic>U<\/jats:italic> test were used for analysis.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001179_as5\"><jats:title>Results:<\/jats:title><jats:p>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 (<jats:italic>P<\/jats:italic> &lt; .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13\u201323 months (<jats:italic>P<\/jats:italic> &lt; .001) and all ages combined (<jats:italic>P<\/jats:italic> = .003).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X22001179_as6\"><jats:title>Conclusion:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2022.117","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T07:34:23Z","timestamp":1655278463000},"page":"186-190","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Successful diagnostic stewardship for <i>Clostridioides difficile<\/i> testing in pediatrics"],"prefix":"10.1017","volume":"44","author":[{"given":"Katia C.","family":"Halabi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen P.","family":"Acker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Marie","family":"Cannon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Messina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Mangino","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystal","family":"Balzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2411-2712","authenticated-orcid":false,"given":"Alexandra","family":"Hill-Ricciuti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Green","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars F.","family":"Westblade","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2087-1044","authenticated-orcid":false,"given":"Christine M.","family":"Salvatore","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7231-8451","authenticated-orcid":false,"given":"Lisa","family":"Saiman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2022,6,15]]},"reference":[{"key":"S0899823X22001179_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.16"},{"key":"S0899823X22001179_ref8","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2018.347"},{"key":"S0899823X22001179_ref9","unstructured":"9. National Healthcare Safety Network. Multidrug-resistant organism and Clostridioides difficile (MDRO\/CDI) infection surveillance and LabID event reporting module. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/psc\/cdiff\/. Updated January 1, 2021. Accessed February 21, 2021."},{"key":"S0899823X22001179_ref3","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000000666"},{"key":"S0899823X22001179_ref11","first-page":"142","article-title":"Impact of a healthcare provider educational intervention on frequency of Clostridium difficile polymerase chain reaction testing in children: a segmented regression analysis","volume":"6","author":"Kociolek","year":"2017","journal-title":"J Pediatric Infect Dis Soc"},{"key":"S0899823X22001179_ref6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.03014-15"},{"key":"S0899823X22001179_ref2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000556"},{"key":"S0899823X22001179_ref12","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02319-16"},{"key":"S0899823X22001179_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy149"},{"key":"S0899823X22001179_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofaa366"},{"key":"S0899823X22001179_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.07.016"},{"key":"S0899823X22001179_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu302"},{"key":"S0899823X22001179_ref1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e3181d29767"},{"key":"S0899823X22001179_ref5","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1128\/CMR.00016-13","article-title":"Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories","volume":"26","author":"Burnham","year":"2013","journal-title":"Clin Microbiol Rev"},{"key":"S0899823X22001179_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa152"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X22001179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T12:04:05Z","timestamp":1698753845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X22001179\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,15]]},"references-count":15,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2]]}},"alternative-id":["S0899823X22001179"],"URL":"https:\/\/doi.org\/10.1017\/ice.2022.117","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,15]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}