C Diff Drug Stewardship

A presentation at the APIC 2023 annual conference was about reducing the unnecessary treatment of asymptomatic bacteria, and the presenters shared some of the successful strategies they have implemented at their hospital.

Reducing tests has benefits like better antibiotic use and fewer hospital infections. It can also prevent some cases of catheter-associated UTIs.

Nature Communications - Drugs can impact the gut microbiome. Here, Algavi and Borenstein developed a machine-learning framework that successfully predicts the impact of thousands of drugs on...

Background No research has been conducted to assess whether antibiotic prophylaxis prescribing differs by dental setting. Therefore, the goal of this study was to compare the prescribing of antibiotic prophylaxis in Veterans Affairs (VA) and non-Veterans Affairs settings. Methods This was a retrospective study of veteran and non-veteran dental patients with cardiac conditions or prosthetic joints between 2015–2017. Multivariable log binomial regression analysis was conducted to compare concordant prescribing by setting with a sub-analysis for errors of dosing based on antibiotic duration (i.e., days prescribed). Results A total of 61,124 dental visits that received a prophylactic antibiotic were included. Most were male (61.0%), and 55 years of age or older (76.2%). Nearly a third (32.7%) received guideline concordant prophylaxis. VA dental settings had a lower prevalence of guideline concordant prescribing compared to non-VA settings in unadjusted results (unadjusted prevalence ratio [uPR] = 0.92, 95% CI: 0.90–0.95). After adjustment, prevalence of guideline concordant prescribing was higher in those with prosthetic joints in the VA setting (adjusted prevalence ratio [aPR] = 1.73, 95% CI: 1.59–1.88), with no difference identified in those without a prosthetic joint (aPR = 0.99, 95% CI: 0.96–1.01). Concordance of dosing was higher in VA compared to non-VA settings (aPR = 1.11, 95% CI: 1.07–1.15). Conclusions VA has a higher prevalence of guideline concordant prescribing among those with prosthetic joints and when assessing dosing errors. Though the presence of an integrated electronic health record (EHR) may be contributing to these differences, other system or prescriber-related factors may be responsible. Future studies should focus on to what extent the integrated EHR may be responsible for increased guideline concordant prescribing in the VA setting.

In this small, retrospective, single-center, quasi-experimental study, there was no difference in 30-day mortality in patients receiving treatment with clindamycin plus vancomycin versus linezolid in combination with standard gram-negative and anaerobic therapy and surgical debridement for the treat …

Cephalosporin treatment is a risk factor of Clostridioides difficile infection.

Collaboration and teamwork are essential components in addressing UTI management and antibiotic resistance, explains infectious disease clinical specialist Kim Leuthner, PharmD, FIDSA.

Proton pump inhibitors (PPIs) are commonly prescribed for various conditions, but their long-term use without evaluation can lead to dependence and associated risks, emphasizing the importance of appropriate monitoring and deprescribing.

“My pharmacist @CVSHealth is now calling dentists who prescribe Clindamycin & informing their patients of risk of #cdiff & their Rx does not align with ABX prophylaxis guidelines. He is getting pushback from the dentists and now their pts are coming back with CDI and Dificid Rx.”

Introduction Clostridium difficile (C. difficile) is one of the major causes of diarrhea transmitted by the fecal-oral route. C. difficile type BI/NAP1/027 is responsible for the most severe C. difficile infection (CDI). It is a major cause of antibiotic-associated diarrh …

Structured PAF showed clinical outcomes similar to ad hoc PAF. Structured PAF was well received and was perceived as beneficial by surgical staff.

Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada) - Volume 43 Issue 2

In our large-scale study of 68,633 Koreans with new-onset IBD between 2004 and 2018, we demonstrated dose-dependent relationship between antibiotics use and IBD development.

Monthly intramuscular antibiotic prophylaxis was demonstrated to be effective in reducing cellulitis recurrence

Five medical organizations say it is essential that hospitals establish antimicrobial stewardship programs to prevent Clostridioides difficile (C. difficile) infections.

Study suggests antimicrobial used to promote livestock growth breeds bacteria more resistant to our natural defences

First-line vancomycin and second-line vancomycin was the most cost-effective treatment sequence at the NICE threshold for treating CDI in England. The main limitation of this study was that the initial cure and recurrence rates of each intervention were applied constantly across each line of treatme …

Unnecessary antibiotics for viral infections and incorrect prescriptions for bacterial infections have significant consequences, including increased adverse effects and healthcare expenditures.

Study showed how Enterococcus fine tunes the environment around C. diff, restricting some nutrients and supplying others, to increase its fitness and virulence.

Researchers found an increased occurrence of CDI in individuals who were prescribed antidepressants.

Antibiotics no longer work against many infections due to MDROs, causing more illness and death. What is antimicrobial resistance (AMR) doing to the environment?

Background Little evidence exists regarding the prevalence of pathogens in bloodstream infections (BSIs), the mortality risk, and the benefit of combination therapy over monotherapy. This study aims to describe patterns of empiric antimicrobial therapy, and the epidemiology of Gram-negative pathogens, and to investigate the effect of appropriate therapy and appropriate combination therapy on the mortality of patients with BSIs. Methods This was a retrospective cohort study including all patients with BSIs of Gram-negative pathogens from January 2017 to December 2022 in a Chinese general hospital. The in-hospital mortality was compared between appropriate and inappropriate therapy, and between monotherapy and combination therapy for patients receiving appropriate therapy. We used Cox regression analysis to identify factors independently associated with in-hospital mortality. Results We included 205 patients in the study, of whom 147 (71.71%) patients received appropriate therapy compared with 58 (28.29%) who received inappropriate therapy. The most common Gram-negative pathogen was Escherichia coli (37.56%). 131 (63.90%) patients received monotherapy and 74 (36.10%) patients received combination therapy. The in-hospital mortality was significantly lower in patients administered appropriate therapy than inappropriate therapy (16.33% vs. 48.28%, p = 0.004); adjusted hazard ratio [HR] 0.55 [95% CI 0.35–0.84], p = 0.006). In-hospital mortality was also not different in combination therapy and monotherapy in the multivariate Cox regression analyses (adjusted HR 0.42 [95% CI 0.15–1.17], p = 0.096). However, combination therapy was associated with lower mortality than monotherapy in patients with sepsis or septic shock (adjusted HR 0.94 [95% CI 0.86–1.02], p = 0.047). Conclusions Appropriate therapy was associated with a protective effect on mortality among patients with BSIs due to Gram-negative pathogens. Combination therapy was associated with improved survival in patients with sepsis or septic shock. Clinicians need to choose optical empirical antimicrobials to improve survival outcomes in patients with BSIs.

Five medical organizations say it is essential that hospitals establish antimicrobial stewardship programs to prevent Clostridioides difficile (C. difficile) infections.

Non-steroidal anti-inflammatory drugs (NSAID) and antibiotics can trigger IBD. But antibiotic usage is important in some situations in IBD.

Introduction Clostridium difficile (C. difficile) is one of the major causes of diarrhea transmitted by the fecal-oral route. C. difficile type BI/NAP1/027 is responsible for the most severe C. difficile infection (CDI). It is a major cause of antibiotic-associated diarrhea followed by Clostridium perfringens, Staphylococcus aureus, and Klebsiella oxytoca. Historically, clindamycin, cephalosporins, penicillins, and fluoroquinolones were related to CDI. We conducted this study to evaluate the antibiotics associated with CDI in recent times. Methods We conducted a retrospective, single-center study over a period of eight years. A total of 58 patients were enrolled in the study. Patients with diarrhea and positive C. difficile toxin in stool were evaluated for antibiotics given, age, presence of malignancy, previous hospital stay for more than three days in the last three months, and any comorbidities. Results Among patients who developed CDI, prior antibiotics for at least four days duration were given in 93% (54/58) of patients. The most common antibiotics associated with C. difficile infection were piperacillin/tazobactam in 77.60% (45/58), meropenem in 27.60% (16/58), vancomycin in 20.70% (12/58), ciprofloxacin in 17.20% (10/58), ceftriaxone in 16% (9/58), and levofloxacin in 14% (8/58) of patients, respectively. Seven percent (7%) of patients with CDI did not receive any prior antibiotics. Solid organ malignancy was present in 67.20% and hematological malignancy in 27.60% of CDI patients. Ninety-eight percent (98%, 57/58) of patients treated with proton pump inhibitors, 93% of patients with a previous hospital stay for more than three days, 24% of patients with neutropenia, 20.1% of patients aged more than 65 years, 14% of patients with diabetes mellitus, and 12% of patients with chronic kidney disease also developed C. difficile infection. Conclusion The antibiotics associated with C. difficile infection are piperacillin/tazobactam, meropenem, vancomycin, ciprofloxacin, ceftriaxone, and levofloxacin. Other risk factors for CDI are proton pump inhibitor use, prior hospital admission, solid organ malignancy, neutropenia, diabetes mellitus (DM), and chronic kidney disease (CKD).

Structural-racism-and-systemic-injustices-inhibit-the-ability-to-have-equitable-healthcare-also-negatively-impacts-antimicrobial-stewardship-according-to-Jacinda

Introduction Clostridium difficile (C. difficile) is one of the major causes of diarrhea transmitted by the fecal-oral route. C. difficile type BI/NAP1/027 is responsible for the most severe ...

A review of the 2023 updated Beers Criteria for potentially inappropriate medication use in older adults

A clinician provides insights on this significant topic as well as resources in finding information on them.

Research into microbial extracellular vesicles has progressed significantly over several decades. Current research suggests bacterial extracellular vesicles derived from probiotic bacteria may be the postbiotics of the future with potential health benefits.