C Diff Drug Stewardship

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Antibiotics work by either killing the bacteria directly or by inhibiting the growth of bacteria.

Outpatient-AMS-efforts-at-many-medical-centers-took-a-back-seat-during-the-COVID-19-pandemic-but-now-is-a-good-time-to-revamp-them-presenters-said-at-the-2022-ACCP

/PRNewswire/ -- Why do nonsteroidal anti-inflammatory drugs (NSAIDs) exacerbate gastrointestinal infections by Clostridioides difficile, the leading cause of...

A recent article in USA Today proclaimed that we are *this* far away from no longer having working antibiotics, a cataclysmic development that would pose "an existential threat for modern medicine."

Correction: Cost-Effectiveness Analysis of Antimicrobial Prescribing in the Treatment of Clostridioides Difficile Infection in England

Nature Reviews Microbiology - In this Review, de Nies, Kobras and Stracy examine the detrimental effects of antibiotics on the microbiota and the resulting associated infections. They delve into...

In the German university hospital setting, monthly ward-level carbapenem consumption seems to increase the HAHO-CDI incidence density predominantly on haematological-oncological wards. Furthermore, other patient-specific factors seem to be equally important to control HAHO-CDI.

The recently published Prophylactic Antibiotic Regimens In Tumor Surgery (PARITY) trial found no benefit in extending antibiotic prophylaxis from 24 hours to five days after endoprosthetic reconstruction for lower limb bone tumours. PARITY is the first randomized controlled trial in orthopaedic onco …

Proton pump inhibitors (PPIs) are one of the most commonly prescribed drug groups in developed countries. Their approved indications include gastroesophageal reflux disease, peptic ulcer disease, and prophylaxis against NSAID-induced gastroenteropathy in specific scenarios. Since their introduction …

Racial-disparities-continue-to-impede-antimicrobial-stewardship-among-antibiotic-prescribing-for-patients-with-CDI-and-Candidemia-according-to-according-to-Jacinda

This study revealed a high prevalence of PPI use among elderly populations in BC, Canada. The overutilization of PPIs is often a result of failure to re-evaluate the need for continuation of therapy. Published studies identified signals of serious harm from long-term PPI exposure. Healthcare provide …

The data could inform how non–steroidal anti-inflammatory drug-mediated mitochondrial uncoupling could affect other diseases.

Background Antibiotic usage and antibiotic resistance (ABR) patterns changed during the COVID-19 pandemic. Inadequate empiric antibiotic therapy (IET) is a significant public health problem and contributes to ABR. We evaluated factors associated with IET before and during the COVID-19 pandemic to determine the impact of the pandemic on antibiotic management. Methods This multicenter, retrospective cohort analysis included hospitalized US adults who had a positive bacterial culture (specified gram-positive or gram-negative bacteria) from July 2019 to October 2021 in the BD Insights Research Database. IET was defined as antibacterial therapy within 48 h that was not active against the bacteria. ABR results were based on susceptibility testing and reports from local facilities. Multivariate analysis was used to identify risk factors associated with IET in patients with any positive bacterial culture and ABR-positive cultures, including multidrug-resistant (MDR) bacteria. Results Of 278,344 eligible patients in 269 hospitals, 56,733 (20.4%) received IET; rates were higher in patients with ABR-positive (n = 93,252) or MDR-positive (n = 39,000) cultures (34.9% and 45.0%, respectively). Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-positive patients had significantly higher rates of IET (25.9%) compared with SARS-CoV-2-negative (20.3%) or not tested (19.7%) patients overall and in the ABR and MDR subgroups. Patients with ABR- or MDR-positive cultures had more days of therapy and longer lengths of stay. In multivariate analyses, ABR, MDR, SARS-CoV-2-positive status, respiratory source, and prior admissions were identified as key IET risk factors. Conclusions IET remained a persistent problem during the COVID-19 pandemic and occurred at higher rates in patients with ABR/MDR bacteria or a co-SARS-CoV-2 infection.

Nature Reviews Microbiology - In this Review, Fishbein, Mahmud and Dantas discuss factors that influence restructuring of the gut microbiome on antibiotic exposure, and they explore promising...

Doxycycline is a commonly prescribed antibiotic for bacterial sinus infections. Learn more about how it works and what to expect when you start taking it.

A history of Clostridium difficile infection (CDI) before total knee arthroplasty (TKA) may be a marker for poor patient health and could be used to identify patients with higher risks for complications after TKA. We compared the frequency of 90-day postoperative CDI, complications, readmissi …

Clostridioides difficile damages the colonic mucosa through the action of two potent exotoxins. Factors shaping C. difficile pathogenesis are incompletely understood but are likely due to the ecological factors in the gastrointestinal ecosystem, mucosal immune responses, and environmen …

Results could provide insights into how NSAID-mediated mitochondrial uncoupling affects diseases such as small intestinal injury, IBD, and colorectal cancer.

Why do nonsteroidal anti-inflammatory drugs (NSAIDs) exacerbate gastrointestinal infections by Clostridioides difficile, the leading cause of antibiotic-associated diarrhea worldwide? In a new paper published in Science Advances, researchers at Children's Hospital of Philadelphia (CHOP) have begun to answer that question, showing that NSAIDs disrupt the mitochondria of cells lining the colon, sensitizing them to damage by pathogenic toxins.

Our study did not identify an increased risk of CDI associated with vedolizumab vs anti-TNFa agents after controlling for UC severity. We hope that these findings will reassure UC providers considering vedolizumab as a first-line biologic agent in the context of gastrointestinal infectious risks.

Overuse of antibiotics increases adverse side effects, including C diff

Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship …

Misclassification of iClostridioides difficile/i colonization as hospital-onset iC. difficile/i infection (HO-CDI) can lead to unnecessary treatment of patients and substantial financial penalties for hospitals. We successfully implemented mandatory iC. difficile/i PCR testing approval a …

Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship …

Inappropriate dental antibiotic prescriptions to prevent infective endocarditis in the United States results in ∼$31 million in excess costs to the healthcare system and patients. This includes out-of-pocket costs ($20.5 million), drug costs ($2.69 million) and adverse event costs (eg, Clostridio …

“#Antibiotics make you 7x more likely to get a #Cdiff infection—learn how to help protect yourself at https://t.co/Hx0mpJWb7f and https://t.co/YbavFZUqvO #BeAntibioticsAware #SeeCdiff @PeggyFund”

Although prior PPI use might not have significant impact on clinical course and mortality of SARS-CoV-2 infection, it may predispose development of complications like higher occurrence of Cdiff, and thus substantially impact the course of treatment.

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.