I work in a nursing home/sub-acute rehab but I figured everyone could probably offer input or feedback.
We just had a resident complete 2 rounds of ABT for c-diff. He completed a 14-day round of Flagyl and was still having loose stool. A C&S was obtained and send to the lab. The culture came back positive for c-diff antigen and toxin. The result was called into the MD and he started the resident on Vancomycin for 14 days. It seems that no one ever received or called in the sensitivity results to the MD. The resident just completed the course of PO Vanco QID x 14 days last week and is still having loose stool. By chance, we discovered the sensitivity from the stool obtained at the beginning of September for this resident. I called the MD with results, and of course the sensitivity said the c-diff was resistant to Vanc. The MD ordered to re-start the resident on Flagyl, with no specified stop date for treatment. Apparently I wasn't clear enough that the sensitivity had been obtained after he started the Vanc but not after he had completed it. No final C&S had been obtained after he completed the Vanc.
The resident was restarted on Flagyl but when the MD discovered that even though he was resistent to the Vanc, he completed the course of ABT and got better, so we were just supposed to leave it at that, regardless of the sensitivity that came back after it had been ordered. The MD d/c'ed the Flagyl and there are no new orders at this point. No C&S, nothing. Apparently, it's common practice to not test stool after completing a course of ABT to see if the resident still has c-diff unless they're symptomatic, which he was, but that wasn't made 100% clear to the MD.
Doc is now pitching a fit and things are going up the food chain to the DON and the Medical Director.
Do any of y'all have a policy of re-testing stool after completing ABT for c-diff?