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Clostridium difficile AND antimicrobial stewardship

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https://www.readbyqxmd.com/read/28622340/antibiotic-prophylaxis-for-surgical-site-infections-as-a-risk-factor-for-infection-with-clostridium-difficile
#1
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
#2
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...
June 14, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28603609/antimicrobial-susceptibility-of-clostridium-difficile-isolated-in-thailand
#3
Papanin Putsathit, Monthira Maneerattanaporn, Pipat Piewngam, Daniel R Knight, Pattarachai Kiratisin, Thomas V Riley
BACKGROUND: Exposure to antimicrobials is the major risk factor associated with Clostridium difficile infection (CDI). Paradoxically, treatment of CDI with antimicrobials remains the preferred option. To date, only three studies have investigated the antimicrobial susceptibility of C. difficile from Thailand, two of which were published in the 1990s. This study aimed to investigate the contemporary antibiotic susceptibility of C. difficile isolated from patients in Thailand. METHODS: A collection of 105 C...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28542111/clostridium-difficile-infection-in-solid-organ-transplant-recipients
#4
Deepa Nanayakkara, Neha Nanda
PURPOSE OF REVIEW: Clostridium difficile infection (CDI) is a major healthcare-associated infection that causes significant morbidity and an economic impact in the United States. In this review, we provide an overview of Clostridium difficile infection in solid organ transplant recipients with an emphasis on recent literature. RECENT FINDINGS: C. difficile in solid organ transplant population has unique risk factors. Fecal microbiota transplantation has shown favorable results in treatment of recurrent C...
May 24, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28538249/norovirus-and-clostridium-difficile-outbreaks-squelching-the-wildfire
#5
Ann Fisher, Louise M Dembry
PURPOSE OF REVIEW: Gastrointestinal outbreaks in the healthcare setting cause increased morbidity and mortality in an already vulnerable population. Optimization of infection prevention measures can be a challenge in healthcare settings. This review describes new literature that may change the traditional infection prevention approach to such outbreaks. RECENT FINDINGS: Asymptomatic carriers of both norovirus and Clostridium difficile can pose risk of transmission to others and the environment...
May 22, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#6
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28526309/antimicrobial-stewardship-for-hospitalized-patients-with-viral-respiratory-tract-infections
#7
Christopher F Lowe, Michael Payne, David Puddicombe, Allison Mah, Davie Wong, Allison Kirkwood, Mark W Hull, Victor Leung
BACKGROUND: The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection. METHODS: This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation)...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28480242/outcomes-associated-with-antimicrobial-de-escalation-of-treatment-for-pneumonia-within-the-veterans-healthcare-administration
#8
Jefferson G Bohan, Richard Remington, Makoto Jones, Matthew Samore, Karl Madaras-Kelly
De-escalation, an antimicrobial stewardship concept, involves narrowing broad-spectrum empiric antimicrobial therapy based on clinical data. Current health outcomes evidence is lacking to support de-escalation. Studying Veterans Healthcare Administration pneumonia patients, de-escalation was associated with improved length of stay without affecting 30-day readmission or 30-day Clostridium difficile infection rates.
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28476493/promoting-appropriate-urine-culture-management-to-improve-health-care-outcomes-and-the-accuracy-of-catheter-associated-urinary-tract-infections
#9
REVIEW
Robert Garcia, Eric D Spitzer
Published literature indicates that the unjustified ordering or improper collection of urine for urinalysis or culture from either catheterized patients or those without indwelling devices, or misinterpretation of positive results, often leads to adverse health care events, including increased financial burdens, overreporting of mandated catheter-associated urinary tract infection events, overtreatment of patients with antimicrobial agents, selection of multidrug-resistant organisms, and Clostridium difficile infection...
May 2, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28444166/the-effect-of-a-piperacillin-tazobactam-shortage-on-antimicrobial-prescribing-and-clostridium-difficile-risk-in-88-u-s-medical-centers
#10
Alan E Gross, Richard S Johannes, Vikas Gupta, Ying P Tabak, Arjun Srinivasan, Susan C Bleasdale
Background: Anti-infective shortages are a pervasive problem in the U.S. The objective of this study was to identify any associations between changes in antibiotic prescribing during a piperacillin/tazobactam (PIP/TAZO) shortage and hospital-onset Clostridium difficile infection (HO-CDI) risk in 88 U.S medical centers. Methods: We analyzed electronically captured microbiology and antibiotic use data from a network of U.S. hospitals from July 2014 through June 2015...
April 24, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28399946/impact-of-a-multifaceted-antimicrobial-stewardship-program-a-front-line-ownership-driven-quality-improvement-project-in-a-large-urban-emergency-department
#11
Adam Jonathan Kaufman, Janine McCready, Jeff Powis
BACKGROUND: Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers...
April 12, 2017: CJEM
https://www.readbyqxmd.com/read/28371928/does-electronic-stewardship-work
#12
Barbara B Lambl, Nathan Kaufman, Janice Kurowski, W O'Neill, Frederick Buckley, Maureen Duram, Barbara Swartz, Duncan Phillips, Mitchell Rein, Marc Rubin
Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital. Hospital-acquired Clostridium difficile infections declined 24% (P = .07).
March 21, 2017: Journal of the American Medical Informatics Association: JAMIA
https://www.readbyqxmd.com/read/28348151/effect-of-a-health-care-system-respiratory-fluoroquinolone-restriction-program-to-alter-utilization-and-impact-rates-of-clostridium-difficile-infection
#13
Katherine M Shea, Athena L V Hobbs, Theresa C Jaso, Jack D Bissett, Christopher M Cruz, Elizabeth T Douglass, Kevin W Garey
Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41...
June 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28333302/outcomes-of-multisite-antimicrobial-stewardship-programme-implementation-with-a-shared-clinical-decision-support-system
#14
Stuart E Bond, Adriana J Chubaty, Suman Adhikari, Spiros Miyakis, Craig S Boutlis, Wilfred W Yeo, Marijka J Batterham, Cara Dickson, Brendan J McMullan, Mona Mostaghim, Samantha Li-Yan Hui, Kate R Clezy, Pamela Konecny
Background: Studies evaluating antimicrobial stewardship programmes (ASPs) supported by computerized clinical decision support systems (CDSSs) have predominantly been conducted in single site metropolitan hospitals. Objectives: To examine outcomes of multisite ASP implementation supported by a centrally deployed CDSS. Methods: An interrupted time series study was conducted across five hospitals in New South Wales, Australia, from 2010 to 2014...
March 14, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28300019/clostridium-difficile-infection-in-acute-care-hospitals-systematic-review-and-best-practices-for-prevention
#15
Irene K Louh, William G Greendyke, Emilia A Hermann, Karina W Davidson, Louise Falzon, David K Vawdrey, Jonathan A Shaffer, David P Calfee, E Yoko Furuya, Henry H Ting
OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates...
April 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28295646/the-epidemiology-of-clostridium-difficile-infection-in-a-national-kidney-transplant-center
#16
Claire Kennedy, Carmel Waldron, Mairead Skally, Leah Gaughan, Colm Magee, Karen Burns, Fidelma Fitzpatrick
BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant center from 2008 to 2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10 000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs...
March 15, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28274985/role-of-postgraduate-year-2-pharmacy-residents-in-providing-weekend-antimicrobial-stewardship-coverage-in-an-academic-medical-center
#17
Justin Siegfried, Cristian Merchan, Marco R Scipione, John Papadopoulos, Arash Dabestani, Yanina Dubrovskaya
PURPOSE: The integration of pharmacy residents into an antimicrobial stewardship program (ASP) is described, and data on the residents' ASP interventions and outcomes are reported. SUMMARY: ASP coverage of nighttime, holiday, and weekend shifts is often provided by infectious diseases (ID) medical fellows and staff pharmacists, potentially leading to inconsistent stewardship practices. As part of an initiative by a large urban hospital to provide around-the-clock, comprehensive ASP services 7 days a week, postgraduate year 2 (PGY2) pharmacy residents in ID or critical care were assigned to provide ASP coverage on weekends...
March 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28239451/management-of-a-cluster-of-clostridium-difficile-infections-among-patients-with-osteoarticular-infections
#18
Jacqueline Färber, Sebastian Illiger, Fabian Berger, Barbara Gärtner, Lutz von Müller, Christoph H Lohmann, Katja Bauer, Christina Grabau, Stefanie Zibolka, Dirk Schlüter, Gernot Geginat
BACKGROUND: Here we describe a cluster of hospital-acquired Clostridium difficile infections (CDI) among 26 patients with osteoarticular infections. The aim of the study was to define the source of C. difficile and to evaluate the impact of general infection control measures and antibiotic stewardship on the incidence of CDI. METHODS: Epidemiological analysis included typing of C. difficile strains and analysis of possible patient to patient transmission. Infection control measures comprised strict isolation of CDI patients, additional hand washings, and intensified environmental cleaning with sporicidal disinfection...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28131640/the-burden-of-healthcare-associated-clostridium-difficile-infection-in-a-non-metropolitan-setting
#19
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...
April 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28130063/effects-of-control-interventions-on-clostridium-difficile-infection-in-england-an-observational-study
#20
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...
April 2017: Lancet Infectious Diseases
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