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Introduction This study examined the effect of an alert notifying providers ordering Clostridium difficile PCR when their patient received a laxative within 24 hours at four hospitals. Methods All patients whose provider received the laxative alert when ordering C. difficile testing were examined. Results Three hundred sixty-six patients had 483 alerts triggered, with 75% overridden. While 74% of patients had ≥2 bowel movements immediately pre-order, 33% of C. difficile tests were not performed due to no stool production post-order or laboratory rejection of formed stool. Of those with completed tests, 49% had ≤1 cardinal sign of C. difficile infection (CDI) and only 18% tested positive by PCR. There were no differences in frequency of CDI signs between the PCR-positive and PCR-negative patients. Conclusions C. difficile testing was common among patients receiving laxatives. Patients testing positive for C. difficile looked clinically similar to patients testing negative, suggesting a high false-positive rate. [ABSTRACT FROM AUTHOR]

Preauthorization strategies, including restricting broad-spectrum antimicrobials such as carbapenems to infectious diseases physicians (ID) are commonly employed by stewardship programs. The appropriateness, or “necessity” of empiric carbapenem therapy by ID, defined as an isolated organism sensitive to the carbapenem and resistant to cefepime, was evaluated over a 6 month span and included 84 patients. Additionally, 30 patients followed by ID who were not prescribed a carbapenem until final susceptibilities were included as a definitive therapy group. Differences in multi-drug resistant organism (MDRO) risk factors between groups were non-significant. Carbapenem therapy was necessary for only 6 (7%) empiric therapy patients, while four times as many definitive group patients required a carbapenem but did not receive one empirically. Overall, ID's ability to accurately gauge which patients required carbapenems appeared poor in this study. Alternative risk stratification strategies may better guide broad-spectrum antimicrobial use than ID judgment alone. [ABSTRACT FROM AUTHOR]

• Use of the FilmArray meningitis and encephalitis panel was associated with shortened cerebrospinal fluid testing turnaround time. • Shortened turnaround did not consistently result in reduced antimicrobial duration. • Involvement of antimicrobial stewardship programs may optimize FilmArray meningitis and encephalitis outcomes. Ten controlled studies evaluated antimicrobial use following implementation of the FilmArray meningitis and encephalitis panel versus usual care. Only one-half of studies identified significant reductions in antibiotic duration, with 8/10 reporting modest reductions for acyclovir. Coupling the FilmArray meningitis and encephalitis panel with interventions by antimicrobial stewardship programs may help enhance its clinical impact. [ABSTRACT FROM AUTHOR]