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Clostridium difficile AND antimicrobial stewardship

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https://www.readbyqxmd.com/read/29505879/guidance-document-for-prevention-of-clostridium-difficile-infection-in-acute-healthcare-settings
#1
S Tschudin-Sutter, E J Kuijper, A Durovic, M J G T Vehreschild, F Barbut, C Eckert, F Fitzpatrick, M Hell, T Norèn, J O'Driscoll, J Coia, P Gastmeier, L von Müller, M H Wilcox, A F Widmer
SCOPE: Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship...
March 2, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29373980/do-we-need-new-trials-of-procalcitonin-guided-antibiotic-therapy
#2
Thiago Lisboa, Jorge Salluh, Pedro Povoa
Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect of a procalcitonin (PCT)-guided antibiotic treatment on outcomes in acute lower respiratory tract infections (LRTI), suggesting that significant reductions in antibiotic duration occur when using a PCT-guided algorithm. However, controversial evidence also suggested PCT-guided algorithms were associated with increased antibiotic duration and increased incidence of Clostridium difficile, without any impact on mortality, in real-world settings...
January 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29353504/clostridium-difficile-control-measures-current-and-future-methods-for-prevention
#3
Carlos Mejia-Chew, Erik R Dubberke
Clostridium difficile is the most common cause of healthcare associated infection, and C. difficile infection (CDI) is associated with significant costs, morbidity, and mortality. One obstacle to preventing CDI is lack of high quality data on interventions to prevent CDI. This has led some to focus on areas, such as method of hand hygiene, unlikely to impact CDI incidence as much as others, such as contact precautions. In addition, existing strategies, although effective, do have limitations. Another challenge is the ability to rapidly, and accurately, diagnose CDI...
February 2018: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/29305281/impact-of-real-time-notification-of-clostridium-difficile-test-results-and-early-initiation-of-effective-antimicrobial-therapy
#4
Christian B Polen, William R Judd, Patrick D Ratliff, Gregory S King
BACKGROUND: Clostridium difficile is a prominent nosocomial pathogen and is the most common causative organism of health care-associated diarrhea. To our knowledge, no studies have investigated the impact of real-time notification of culture results with rapid antimicrobial stewardship program (ASP) intervention in the setting of C difficile infection (CDI). The purpose of this study was to assess the impact of real-time notification of detection of toxigenic C difficile by DNA amplification results in patients with confirmed CDI...
January 3, 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29276300/multilayer-model-of-pharmacy-participation-in-the-antimicrobial-stewardship-program-at-a-large-academic-medical-center
#5
Yanina Dubrovskaya, Marco R Scipione, Justin Siegfried, Shin-Pung Jen, Vinh Pham, John Papadopoulos, Arnold Decano, Tyler Lewis, Arash Dabestani
Purpose: Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. Summary: During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639)...
October 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29237206/-piperacillin-tazobactam-shortage-central-restriction-and-alternative-recommendations-as-effective-antibiotic-stewardship-intervention-at-a-maximal-care-hospital
#6
Johanna Kessel, Barbara Dolff, Thomas Wichelhaus, Nils Keiner, Michael Hogardt, Claudia Reinheimer, Imke Wieters, Sebastian Harder, Volkhard A J Kempf, Christoph Stephan
Background  Drug supply bottleneck is a worldwide challenge, e. g. the antibiotics Piperacillin/Tazobactam shortage in 2016/2017. The efficacy of an appropriate replacement management was evaluated at the University Hospital Frankfurt (UHF). Methods  The Antibiotic-Stewardship (ABS)-Team at UHF decreed a restriction of PIP/TAZ and provided alternative antibiotic therapy recommendations during the shortage period. Consequences of this intervention on antibiotic consumption and overall costs were investigated...
December 13, 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29224205/healthcare-acquired-infections-prevention-strategies
#7
Shelanah A Fernando, Timothy J Gray, Thomas Gottlieb
Healthcare-acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health-care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi-resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence-based antimicrobial use; infection prevention strategies, to control MRO - particularly methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp...
December 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/29207702/nagging-presence-of-clostridium-difficile-associated-diarrhoea-in-north-india
#8
Rama Chaudhry, Nidhi Sharma, Nitin Gupta, Kamla Kant, Tej Bahadur, Trupti M Shende, Lalit Kumar, Sushil K Kabra
Introduction: Clostridium Difficile Associated Diarrhoea (CDAD) is a significant cause of morbidity in hospitalised patients worldwide. The data on clinical epidemiology of this disease in Indian subcontinent is scarce. Aim: To evaluate the risk factors and clinical course of patients with CDAD. Materials and Methods: A cross-sectional study was planned at our tertiary care centre, All India Institute of Medical Sciences, whereby, all patients who had nosocomial diarrhea between 2010 and 2014 were included in the study...
September 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/29177489/disease-based-antimicrobial-stewardship-a-review-of-active-and-passive-approaches-to-patient-management
#9
Farnaz Foolad, Jerod L Nagel, Gregory Eschenauer, Twisha S Patel, Cynthia T Nguyen
Although new antimicrobial stewardship programmes (ASPs) often begin by targeting the reduction of antimicrobial use, an increasing focus of ASPs is to improve the management of specific infectious diseases. Disease-based antimicrobial stewardship emphasizes improving patient outcomes by optimizing antimicrobial use and increasing compliance with performance measures. Directing efforts towards the comprehensive management of specific infections allows ASPs to promote the shift in healthcare towards improving quality, safety and patient outcome metrics for specific diseases...
December 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29177477/impact-of-antimicrobial-stewardship-interventions-on-clostridium-difficile-infection-and-clinical-outcomes-segmented-regression-analyses
#10
Andrea Patton, Peter Davey, Stephan Harbarth, Dilip Nathwani, Jacqueline Sneddon, Charis A Marwick
Background: Antimicrobial exposure is associated with increased risk of Clostridium difficile infection (CDI), but the impact of prescribing interventions on CDI and other outcomes is less clear. Objectives: To evaluate the effect of an antimicrobial stewardship intervention targeting high-risk antimicrobials (HRA), implemented in October 2008, and to compare the findings with similar studies from a systematic review. Methods: All patients admitted to Medicine and Surgery in Ninewells Hospital from October 2006 to September 2010 were included...
February 1, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29164170/impact-of-procalcitonin-guided-antibiotic-management-on-antibiotic-exposure-and-outcomes-real-world-evidence
#11
Michael R Broyles
Background: Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice. Methods: A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/29075130/national-antimicrobial-stewardship-and-fluoroquinolone-resistant-clostridium-difficile-in-china
#12
Meng Xiao, Jing-Wei Cheng, Timothy Kudinha, Fanrong Kong, Ying-Chun Xu
No abstract text is available yet for this article.
2017: Infection and Drug Resistance
https://www.readbyqxmd.com/read/28980505/clostridium-difficile-infection-new-approaches-to-prevention-non-antimicrobial-treatment-and-stewardship
#13
Maria Adriana Cataldo, Guido Granata, Nicola Petrosillo
Despite the large amount of scientific publications exploring the epidemiology and the clinical management of Clostridium difficile (CD) infection, some issues remain unsolved or need further studies. The aim of this review is to give an update on the hot topics on CD prevention, including stewardship programs, and on the non-microbiological treatment of CD infection. Areas covered: This article will review the importance of minimizing the CD spore shedding in the healthcare environment for potentially reducing CD transmission...
November 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28958443/interhospital-patient-transfers-between-ontario-s-academic-and-large-community-hospitals-increase-the-risk-of-clostridium-difficile-infection
#14
Giulio DiDiodato, Leslie McArthur
BACKGROUND: The objective of this study is to determine the impact of interhospital patient transfers on the risk of Clostridium difficile infection (CDI). METHODS: The number of interhospital patient transfers and CDI cases for 11 academic and 40 large community hospitals (LCHs) were available from 2010-2015. These data were used to compute a CDI score for each sending facility as a measure of CDI pressure on the receiving facility. This CDI score was included as a variable in a multilevel mixed-effect Poisson regression model of CDI cases...
February 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/28943204/considerations-for-antibiotic-prophylaxis-in-head-and-neck-cancer-surgery
#15
Michael P Veve, Susan L Davis, Amy M Williams, John E McKinnon, Tamer A Ghanem
Peri/post-operative antibiotic prophylaxis (POABP) has become standard practice for preventing surgical site infections (SSI) in head and neck cancer patients undergoing microvascular reconstruction, but few data exist on optimal POABP regimens. Current surgical prophylaxis guideline recommendations fail to account for the complexity of microvascular reconstruction relative to other head and neck procedures, specifically regarding wound classification and antibiotic duration. Selection of POABP spectrum is also controversial, and must balance the choice between too narrow, risking subsequent infection, or too broad, and possible unwanted effects (e...
November 2017: Oral Oncology
https://www.readbyqxmd.com/read/28856589/impact-of-a-mixed-educational-and-semi-restrictive-antimicrobial-stewardship-project-in-a-large-teaching-hospital-in-northern-italy
#16
Daniele Roberto Giacobbe, Valerio Del Bono, Malgorzata Mikulska, Giulia Gustinetti, Anna Marchese, Federica Mina, Alessio Signori, Andrea Orsi, Fulvio Rudello, Cristiano Alicino, Beatrice Bonalumi, Alessandra Morando, Giancarlo Icardi, Sabrina Beltramini, Claudio Viscoli
BACKGROUND: The overuse of antimicrobials favors the dissemination of antimicrobial resistance, as well as invasive fungal diseases and Clostridium difficile infections (CDI). In this study, we assessed the impact of a mixed educational and semi-restrictive antimicrobial stewardship (AMS) project in a large teaching hospital in Italy. METHODS: The AMS project was conducted from May 2014 to April 2016. It consisted of two initiatives in two consecutive periods: (1) educational activities; (2) semi-restrictive control of antimicrobial prescribing through a computerized software...
December 2017: Infection
https://www.readbyqxmd.com/read/28757087/associations-between-antimicrobial-stewardship-program-elements-and-clostridium-difficile-infection-performance
#17
Giulia Barlow, Julie Patterson, Jeremy Stultz, Amy L Pakyz
Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank...
December 1, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28750918/susceptibilities-of-clinical-clostridium-difficile-isolates-to-antimicrobials-a-systematic-review-and-meta-analysis-of-studies-since-1970
#18
REVIEW
N Khanafer, N Daneman, T Greene, A Simor, P Vanhems, M Samore, K A Brown
OBJECTIVES: Although exposure to antibiotics can cause Clostridium difficile infection, certain antibiotics are used to treat C. difficile. Measurements of antimicrobial C. difficile activity could help to identify antibiotic risk and emergent resistance. Here, we describe publication patterns relating to C. difficile susceptibilities and estimate minimum inhibitory concentrations (MIC) for antibiotic classes in the published literature between January 1970 and June 2014. METHODS: We queried PUBMED and EMBASE for studies reporting antibiotic C...
February 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28622340/antibiotic-prophylaxis-for-surgical-site-infections-as-a-risk-factor-for-infection-with-clostridium-difficile
#19
Aubrey Balch, Aaron M Wendelboe, Sara K Vesely, Dale W Bratzler
OBJECTIVE: We aimed to measure the association between 2013 guideline concordant prophylactic antibiotic use prior to surgery and infection with Clostridium difficile. DESIGN: We conducted a retrospective case-control study by selecting patients who underwent a surgical procedure between January 1, 2012 and December 31, 2013. SETTING: Large urban community hospital. PATIENTS: Cases and controls were patients age 18+ years who underwent an eligible surgery (i...
2017: PloS One
https://www.readbyqxmd.com/read/28614043/antibiotics-vs-appendectomy-for-acute-uncomplicated-appendicitis-in-adults-review-of-the-evidence-and-future-directions
#20
REVIEW
Jared M Huston, Lillian S Kao, Phillip K Chang, James M Sanders, Sara Buckman, Charles A Adams, Christine S Cocanour, Sarah E Parli, Julia Grabowski, Jose Diaz, Jeffrey M Tessier, Therese M Duane
BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis. METHODS: Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial...
July 2017: Surgical Infections
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