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Clostridium difficile AND antimicrobial stewardship

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https://www.readbyqxmd.com/read/28131640/the-burden-of-healthcare-associated-clostridium-difficile-infection-in-a-non-metropolitan-setting
#1
S E Bond, C S Boutlis, W W Yeo, W A B Pratt, M E Orr, S Miyakis
OBJECTIVE: Healthcare-associated Clostridium difficile infection (HCA-CDI) remains a major cause of morbidity and mortality in industrialized countries. However, few data exist on the burden of HCA-CDI in multi-site non-metropolitan settings. This study examined the introduction of an antimicrobial stewardship programme (ASP) in relation to HCA-CDI rates, and the effect of HCA-CDI on length of stay (LOS) and hospital costs. METHODS: A comparative before-and-after intervention study of patients aged ≥16 years with HCA-CDI from December 2010 to April 2016 across the nine hospitals of a non-metropolitan health district in New South Wales, Australia was undertaken...
December 18, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28130063/effects-of-control-interventions-on-clostridium-difficile-infection-in-england-an-observational-study
#2
Kate E Dingle, Xavier Didelot, T Phuong Quan, David W Eyre, Nicole Stoesser, Tanya Golubchik, Rosalind M Harding, Daniel J Wilson, David Griffiths, Alison Vaughan, John M Finney, David H Wyllie, Sarah J Oakley, Warren N Fawley, Jane Freeman, Kirsti Morris, Jessica Martin, Philip Howard, Sherwood Gorbach, Ellie J C Goldstein, Diane M Citron, Susan Hopkins, Russell Hope, Alan P Johnson, Mark H Wilcox, Timothy E A Peto, A Sarah Walker, Derrick W Crook
BACKGROUND: The control of Clostridium difficile infections is an international clinical challenge. The incidence of C difficile in England declined by roughly 80% after 2006, following the implementation of national control policies; we tested two hypotheses to investigate their role in this decline. First, if C difficile infection declines in England were driven by reductions in use of particular antibiotics, then incidence of C difficile infections caused by resistant isolates should decline faster than that caused by susceptible isolates across multiple genotypes...
January 24, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28118861/a-report-of-the-efforts-of-the-veterans-health-administration-national-antimicrobial-stewardship-initiative
#3
Allison A Kelly, Makoto M Jones, Kelly L Echevarria, Stephen M Kralovic, Matthew H Samore, Matthew B Goetz, Karl J Madaras-Kelly, Loretta A Simbartl, Anthony P Morreale, Melinda M Neuhauser, Gary A Roselle
OBJECTIVE To detail the activities of the Veterans Health Administration (VHA) Antimicrobial Stewardship Initiative and evaluate outcomes of the program. DESIGN Observational analysis. SETTING The VHA is a large integrated healthcare system serving approximately 6 million individuals annually at more than 140 medical facilities. METHODS Utilization of nationally developed resources, proportional distribution of antibiotics, changes in stewardship practices and patient safety measures were reported. In addition, inpatient antimicrobial use was evaluated before and after implementation of national stewardship activities...
January 25, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28028434/infection-prevention-and-control-of-clostridium-difficile-a-global-review-of-guidelines-strategies-and-recommendations
#4
Evelyn Balsells, Teodora Filipescu, Moe H Kyaw, Camilla Wiuff, Harry Campbell, Harish Nair
BACKGROUND: Clostridium difficile is the leading cause of health care-associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. METHODS: We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine...
December 2016: Journal of Global Health
https://www.readbyqxmd.com/read/27999065/electronic-prescribing-system-design-priorities-for-antimicrobial-stewardship-a-cross-sectional-survey-of-142-uk-infection-specialists
#5
Kieran S Hand, Debbie Cumming, Susan Hopkins, Sean Ewings, Andy Fox, Sandya Theminimulle, Robert J Porter, Natalie Parker, Joanne Munns, Adel Sheikh, Taryn Keyser, Richard Puleston
BACKGROUND: The implementation of electronic prescribing and medication administration (EPMA) systems is a priority for hospitals and a potential component of antimicrobial stewardship (AMS). OBJECTIVES: To identify software features within EPMA systems that could potentially facilitate AMS and to survey practising UK infection specialist healthcare professionals in order to assign priority to these software features. METHODS: A questionnaire was developed using nominal group technique and transmitted via email links through professional networks...
December 20, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27927866/expert-consensus-on-metrics-to-assess-the-impact-of-patient-level-antimicrobial-stewardship-interventions-in-acute-care-settings
#6
Rebekah W Moehring, Deverick J Anderson, Ronda L Cochran, Lauri A Hicks, Arjun Srinivasan, Elizabeth S Dodds Ashley
Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobial prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records...
February 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/27908435/antimicrobial-stewardship-programs-that-target-only-high-cost-broad-spectrum-antimicrobials-miss-opportunities-to-reduce-clostridium-difficile-infections
#7
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
#8
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...
January 2017: 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
#9
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
#10
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
#11
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
#12
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...
November 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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
N D Ritchie, S C Irvine, A Helps, F Robb, B L Jones, R A 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. While 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
#19
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
#20
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
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