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Clostridium difficile AND antimicrobial stewardship

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https://www.readbyqxmd.com/read/27908435/antimicrobial-stewardship-programs-that-target-only-high-cost-broad-spectrum-antimicrobials-miss-opportunities-to-reduce-clostridium-difficile-infections
#1
Christine Bui, Elizabeth Zhu, Monica A Donnelley, Machelle D Wilson, Margaret Morita, Stuart H Cohen, Jennifer Brown
Antimicrobial stewardship programs are promoted as a strategy to reduce Clostridium difficile infections. We implemented an antimicrobial stewardship program comprised of formulary restriction plus prospective audit with feedback for high-cost and broad-spectrum antimicrobials. Subsequently, we reviewed all heath care facility-onset, health care facility-associated C difficile infections. We found that most of these infections were associated with the antecedent receipt of nonaudited, and often unnecessary, antimicrobials...
December 1, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27826877/antimicrobial-stewardship-and-environmental-decontamination-for-the-control-of-clostridium-difficile-transmission-in-healthcare-settings
#2
Jason Bintz, Suzanne Lenhart, Cristina Lanzas
We implement an agent-based model for Clostridium difficile transmission in hospitals that accounts for several processes and individual factors including environmental and antibiotic heterogeneity in order to evaluate the efficacy of various control measures aimed at reducing environmental contamination and mitigating the effects of antibiotic use on transmission. In particular, we account for local contamination levels that contribute to the probability of colonization and we account for both the number and type of antibiotic treatments given to patients...
November 8, 2016: Bulletin of Mathematical Biology
https://www.readbyqxmd.com/read/27798214/rasch-analysis-of-the-antimicrobial-self-assessment-toolkit-for-national-health-service-nhs-trusts-asat-v17
#3
Chantelle Bailey, Mary P Tully, Maria Pampaka, Jonathan Cooke
OBJECTIVES: The Antimicrobial Self-Assessment Toolkit for National Health Service (NHS) Trusts (ASAT) was developed to evaluate hospital-based antimicrobial stewardship programmes. Iterative validity investigations of the ASAT were used to produce a 91-item ASAT v17 utilizing qualitative methodology. Rasch analysis was used to generate question (item) behaviour estimates and to investigate the validity of ASAT v17. METHODS: In 2012, the partial credit model (PCM) was used to analyse ASAT responses from 33 NHS Trusts within England...
October 25, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27766987/fear-of-failure-engaging-patients-in-antimicrobial-stewardship-after-fecal-transplantation-for-recurrent-clostridium-difficile-infection
#4
Michelle T Hecker, Edith Ho, Curtis J Donskey
No abstract text is available yet for this article.
October 21, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27745559/an-antimicrobial-stewardship-program-based-on-systematic-infectious-disease-consultation-in-a-rehabilitation-facility
#5
Sara Tedeschi, Filippo Trapani, Maddalena Giannella, Francesco Cristini, Fabio Tumietto, Michele Bartoletti, Annalisa Liverani, Salvatore Pignanelli, Luisa Toni, Roberto Pederzini, Augusto Cavina, Pierluigi Viale
OBJECTIVE To assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital. DESIGN Quasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation. SETTING 150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries. INTERVENTION Beginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions)...
October 17, 2016: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/27742079/the-tipping-point-patients-predisposed-to-clostridium-difficile-infection-and-a-hospital-antimicrobial-stewardship-programme
#6
S D Stites, C A Cooblall, J Aronovitz, S B Singletary, K Micklow, M Sjeime
BACKGROUND: The incidence and severity of Clostridium difficile infection (CDI) have increased in recent years. Predictive models may help to identify at-risk patients before the onset of infection. Early identification of high-risk patients could help antimicrobial stewardship (AMS) programmes and other initiatives to better prevent C. difficile in these patients. AIM: To develop a predictive model that identifies patients at high risk for CDI at the time of hospitalization...
August 24, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/27727031/the-projected-effectiveness-of-clostridium-difficile-vaccination-as-part-of-an-integrated-infection-control-strategy
#7
Esther van Kleef, Sarah R Deeny, Mark Jit, Barry Cookson, Simon D Goldenberg, W John Edmunds, Julie V Robotham
BACKGROUND: Early clinical trials of a Clostridium difficile toxoid vaccine show efficacy in preventing C. difficile infection (CDI). The optimal patient group to target for vaccination programmes remains unexplored. This study performed a model-based evaluation of the effectiveness of different CDI vaccination strategies, within the context of existing infection prevention and control strategies such as antimicrobial stewardship. METHODS: An individual-based transmission model of CDI in a high-risk hospital setting was developed...
November 4, 2016: Vaccine
https://www.readbyqxmd.com/read/27606976/the-epidemiology-of-clostridium-difficile-infection-in-patients-with-cancer
#8
Andrew I T Hebbard, Monica A Slavin, Caroline Reed, Benjamin W Teh, Karin A Thursky, Jason A Trubiano, Leon J Worth
Clostridium difficile infection (CDI) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. Patients with cancer are a specific high-risk group for development of infection. Areas covered: In this review, modifiable and non-modifiable risk factors for CDI in adult patients with haematological malignancy or solid tumours are evaluated. In particular, the contribution of antimicrobial exposure, hospitalisation and gastric acid suppression to risk of CDI are discussed...
November 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27592160/effect-of-an-antimicrobial-stewardship-intervention-on-outcomes-for-patients-with-clostridium-difficile-infection
#9
Hanna K Welch, Jerod L Nagel, Twisha S Patel, Tejal N Gandhi, Benrong Chen, John De Leon, Carol E Chenoweth, Laraine L Washer, Krishna Rao, Gregory A Eschenauer
BACKGROUND: Although antimicrobial stewardship programs (ASPs) are uniquely positioned to improve treatment of Clostridium difficile infection (CDI) through targeted interventions, studies to date have not rigorously evaluated the influence of ASP involvement on clinical outcomes attributed to CDI. METHODS: We performed a quasiexperimental study of adult patients with CDI before (n = 307) and after (n = 285) a real-time ASP review was initiated. In the intervention group, an ASP pharmacist was notified of positive CDI results and consulted with the care team to initiate optimal therapy, minimize concomitant antibiotic and acid-suppressive therapy, and recommend surgical/infectious diseases consultation in complicated cases...
December 1, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27538503/antimicrobial-stewardship-in-paediatrics
#10
REVIEW
Nicola Principi, Susanna Esposito
BACKGROUND: Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed...
2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27536508/a-multi-center-study-of-fidaxomicin-use-for-clostridium-difficile-infection
#11
Dhara N Shah, Fay S Chan, Nandita Kachru, Krutina P Garcia, Holly E Balcer, April P Dyer, John E Emanuel, Michelle D Jordan, Katherine T Lusardi, Geri Naymick, Radhika S Polisetty, Lanny Sieman, Ashley M Tyler, Michael L Johnson, Kevin W Garey
PURPOSE: Fidaxomicin use in real-world clinical practice, especially for severe Clostridium difficile infection (CDI), is mainly based on single-center observational studies. The purpose of this pharmacoepidemiology study was to assess outcomes of patients given fidaxomicin based on episode number and use of concomitant antibiotics. METHODS: Fidaxomicin use over time across included hospitals in the United States was assessed using a large inpatient drug utilization database...
2016: SpringerPlus
https://www.readbyqxmd.com/read/27521583/restrictive-antibiotic-stewardship-associated-with-reduced-hospital-mortality-in-gram-negative-infection
#12
Neil D Ritchie, Sharon C Irvine, Helps Alieen, Robb Fiona, Brian L Jones, R Andrew Seaton
INTRODUCTION: Antimicrobial stewardship has an important role in the control of Clostridium difficile infection (CDI) and antibiotic resistance. An important component of UK stewardship interventions is the restriction of broad-spectrum beta-lactam antibiotics and promotion of agents associated with a lower risk of CDI such as gentamicin. Whilst the introduction of restrictive antibiotic guidance has been associated with improvements in CDI and antimicrobial resistance evidence of the effect on outcome following severe infection is lacking...
August 13, 2016: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/27515147/antimicrobial-stewardship-for-the-infection-control-practitioner
#13
REVIEW
Jerod L Nagel, Keith S Kaye, Kerry L LaPlante, Jason M Pogue
Antibiotic misuse is a serious patient safety concern and a national public health priority. Years of indiscriminant antibiotic use has promoted selection for antibiotic resistant bacteria and Clostridium difficile This crisis has led to clinicians being faced with managing untreatable infections, often in the most vulnerable patient populations. This review summarizes the goals of antimicrobial stewardship programs, the essential members needed to initiate a program, various antimicrobial stewardship strategies, the role of the infection control practitioner in stewardship, barriers to its implementation and maintenance, approaches to measure the impact of a program, and the steps needed to initiate a program...
September 2016: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/27449956/reducing-co-administration-of-proton-pump-inhibitors-and-antibiotics-using-a-computerized-order-entry-alert-and-prospective-audit-and-feedback
#14
Christopher E Kandel, Suzanne Gill, Janine McCready, John Matelski, Jeff E Powis
BACKGROUND: Antibiotics and proton pump inhibitors (PPIs) are associated with Clostridium difficile infection (CDI). Both a computer order entry alert to highlight this association as well as antimicrobial stewardship directed prospective audit and feedback represent novel interventions to reduce the co-administration of antibiotics and PPIs among hospitalized patients. METHODS: Consecutive patients admitted to two General Internal Medicine wards from October 1, 2010 until March 31, 2013 at a teaching hospital in Toronto, Ontario, Canada were evaluated...
2016: BMC Infectious Diseases
https://www.readbyqxmd.com/read/27437421/evaluating-the-effectiveness-of-an-antimicrobial-stewardship-intervention-on-reducing-the-incidence-rate-of-healthcare-associated-clostridium-difficile-infection
#15
Giulio Didiodato, Leslie Mcarthur
No abstract text is available yet for this article.
December 2015: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/27388268/male-veterans-with-complicated-urinary-tract-infections-influence-of-a-patient-centered-antimicrobial-stewardship-program
#16
James F Carbo, Christine A Ruh, Kari E Kurtzhalts, Michael C Ott, John A Sellick, Kari A Mergenhagen
BACKGROUND: The influence of antimicrobial stewardship programs (ASPs) on outcomes in male veterans treated for complicated urinary tract infection has not been determined. METHODS: This was a retrospective cohort study encompassing the study period January 1, 2005-October 31, 2014, which was conducted at a 150-bed Veterans Affairs Healthcare System facility in Buffalo, NY. Male veterans admitted for treatment of complicated urinary tract infection were identified using ICD-9-CM codes...
December 1, 2016: American Journal of Infection Control
https://www.readbyqxmd.com/read/27349712/impact-of-antimicrobial-stewardship-on-outcomes-in-hospitalized-veterans-with-pneumonia
#17
Kari E Kurtzhalts, John A Sellick, Christine A Ruh, James F Carbo, Michael C Ott, Kari A Mergenhagen
PURPOSE: The purpose of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on outcomes for inpatients with pneumonia, including length of stay, treatment duration, and 30-day readmission rates. METHODS: A retrospective chart review comparing outcomes of veterans admitted with pneumonia before (2005-2006) and after (2013-2014) implementation of an ASP was conducted; pneumonia was defined according to International Classification of Diseases, Ninth Revision (ICD-9) codes...
July 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27348802/vital-signs-preventing-antibiotic-resistant-infections-in-hospitals-united-states-2014
#18
EDITORIAL
Lindsey M Weiner, Scott K Fridkin, Zuleika Aponte-Torres, Lacey Avery, Nicole Coffin, Margaret A Dudeck, Jonathan R Edwards, John A Jernigan, Rebecca Konnor, Minn M Soe, Kelly Peterson, L Clifford McDonald
BACKGROUND: Healthcare-associated antibiotic-resistant (AR) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. CDC assessed healthcare-associated infections (HAI), including Clostridium difficile infections (CDI), and the role of six AR bacteria of highest concern nationwide in several types of healthcare facilities. METHODS: During 2014, approximately 4000 short-term acute care hospitals, 501 long-term acute care hospitals, and 1135 inpatient rehabilitation facilities in all 50 states reported data on specific infections to the National Healthcare Safety Network...
July 2016: American Journal of Transplantation
https://www.readbyqxmd.com/read/27309536/evaluating-the-effectiveness-of-an-antimicrobial-stewardship-program-on-reducing-the-incidence-rate-of-healthcare-associated-clostridium-difficile-infection-a-non-randomized-stepped-wedge-single-site-observational-study
#19
Giulio DiDiodato, Leslie McArthur
BACKGROUND: The incidence rate of healthcare-associated Clostridium difficile infection (HA-CDI) is estimated at 1 in 100 patients. Antibiotic exposure is the most consistently reported risk factor for HA-CDI. Strategies to reduce the risk of HA-CDI have focused on reducing antibiotic utilization. Prospective audit and feedback is a commonly used antimicrobial stewardship intervention (ASi). The impact of this ASi on risk of HA-CDI is equivocal. This study examines the effectiveness of a prospective audit and feedback ASi on reducing the risk of HA-CDI...
2016: PloS One
https://www.readbyqxmd.com/read/27258068/isolation-of-c-difficile-carriers-alone-and-as-part-of-a-bundle-approach-for-the-prevention-of-clostridium-difficile-infection-cdi-a-mathematical-model-based-on-clinical-study-data
#20
Christos A Grigoras, Fainareti N Zervou, Ioannis M Zacharioudakis, Constantinos I Siettos, Eleftherios Mylonakis
Clostridium difficile infection is the most common hospital-acquired infection. Besides infected patients, carriers have emerged as a key player in C. difficile epidemiology. In this study, we evaluated the impact of identifying and isolating carriers upon hospital admission on the incidence of CDI incidence and hospital-acquired C. difficile colonization, as a single policy and as part of bundle approaches. We simulated C. difficile transmission using a stochastic mathematical approach, considering the contribution of carriers based on published literature...
2016: PloS One
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