Clinical Impact of Implementing a Specific Clinical Pathway for the Management of Clostridioides difficile Infection

Sep 30, 2026

Despite Clostridioides difficile infection (CDI) being a leading healthcare-associated infection with high morbidity and mortality, evidence on antimicrobial stewardship program (ASP) interventions for CDI is limited. This quasi-experimental pre–post study assessed the clinical impact of implementing a CDI-specific clinical pathway at two Spanish hospitals across three periods: historical, educational-ASP, and intervention. A CDI-specific measures bundle reduced first recurrence in high-risk groups and lowered recurrent-episode readmissions and 30-day mortality.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Infect Dis Ther (2026) 15:85–100 [https://doi.org/10.1007/s40121-025-01261-9](https://doi.org/10.1007/s40121-025-01261-9) ORIGINAL RESEARCH Clinical Impact of Implementing a Specific Clinical Pathway for the Management of Clostridioides difficile Infection Miguel Rodríguez‑Fernández · Rocio Herrero · Pilar González‑De‑La‑Aleja · María Dolores Valverde‑Fredet · María‑Paz Ventero · Marta Trigo‑Rodríguez · Livia Giner · Ana Isabel Aller‑García · Héctor Pinargote‑Celorio · Reinaldo Espíndola‑Gómez · Mónica Parra · Pedro Martínez Pérez‑Crespo · José‑Manuel Ramos‑Rincón · Antonio Fernández‑Pevida · Joaquín Lanz‑García · Eva León · Lucía Valiente‑De‑Santis · Juan E. Corzo · Juan‑Carlos Rodríguez · Esperanza Merino · Nicolás Merchante Received: September 13, 2025 / Accepted: October 24, 2025 / Published online: November 7, 2025 © The Author(s) 2025 ABSTRACT Introduction: Despite Clostridioides difficile infection (CDI) being a leading healthcare‑ associated infection with high morbimortality, there is little evidence on specific antimicrobial | Esperanza Merino and Nicolás Merchante contributed equally to this work. | | --- | | Supplementary Information The online version contains supplementary material available at [https://doi.org/10.1007/s40121](https://doi.org/10.1007/s40121)‑025‑01261‑9. | M. Rodríguez‑Fernández · R. Herrero · M. D. Valverde‑Fredet · M. Trigo‑Rodríguez · A. I. Aller‑García · R. Espíndola‑Gómez · P. Martínez Pérez‑Crespo · A. Fernández‑Pevida · J. Lanz‑García · E. León · L. Valiente‑De‑Santis · J. E. Corzo · N. Merchante (*) Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme. Universidad de Sevilla. Instituto de Biomedicina de Sevilla, IBiS (Universidad de Sevilla, Junta de Andalucía, CSIC), Seville, Spain e‑[mail: nicolasmerchante@gmail.com](mail: nicolasmerchante@gmail.com) P. González‑De‑La‑Aleja · M.‑P. Ventero · L. Giner · H. Pinargote‑Celorio · M. Parra · J.‑M. Ramos‑Rincón · J.‑C. Rodríguez · E. Merino Unidad de Enfermedades Infecciosas y Microbiología, Hospital General Universitario Dr. Balmis. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) . Universidad Miguel Hernández, Alicante, Spain stewardship program (ASP) interventions for CDI. The objective of this study was to assess the clinical impact of implementing a specific clinical pathway for CDI management at two Spanish hospitals. Methods: This was a quasi‑experimental pre– post intervention study, and three periods were evaluated: historical (2014–2017), educational‑ ASP (2018–2020), and intervention (2021–2023), after implementation of a CDI‑specific measures bundle. Key measures included: (1) updated local CDI guidelines; (2) 24/7 diagnostic testing and real‑time positive results notification to ASP‑CDI team; (3) systematic evaluation of new cases; (4) optimizing CDI antibiotic treatment and overall management; and (5) structured follow‑up until 8 weeks post‑treatment. Primary outcome was first CDI recurrence, and secondary outcomes were readmissions during recurrent CDI episodes and 30‑day all‑cause mortality. Results: In total, there were 1435 patients with CDI included: 370 in the historical period (2014–2017), 537 in the educational‑ASP period (2018–2020), and 528 in the CDI‑specific clini‑ cal pathway period (2021–2023) . First CDI recurrence rates significantly declined across periods in high‑risk groups: immunocompro‑ mised patients, 29% in 2014–2017, 22% in 2018–2020, and 15% in 2021–2023 (p = 0.038); those with severe/fulminant initial CDI, from 38% to 34% to 24%(p = 0.027); and patients aged 65–79 years, from 29% to 31% to 13%(p = 0.003) . Hospitalization during recurrent CDI episodes and mortality were significantly reduced in the CDI‑specific clinical pathway period: readmissions, 11%(2014–2017), 13%(2018–2020), and 6%(2021–2023) (p = 0.017); mortality, 7%, 6%, and 4%(p = 0.023) . Conclusions: The implementation of a struc‑ tured, multif

FAQs

What study objective was assessed for CDI management?

To evaluate the clinical impact of implementing a specific clinical pathway for managing CDI at two Spanish hospitals.

What clinical pathway measures were included in the intervention?

Measures included updated local CDI guidelines, 24/7 diagnostic testing with real-time notification to the ASP-CDI team, systematic evaluation of new cases, optimized antibiotic treatment and overall management, and structured follow-up until 8 weeks post-treatment.

How did outcomes change after implementing the CDI-specific clinical pathway?

First CDI recurrence rates declined in high-risk groups, and hospitalization during recurrent CDI episodes and mortality were significantly reduced during the pathway period.

Sep 30, 2026

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