scholarly journals Clinical and Economic Benefits of Fidaxomicin Compared to Vancomycin for Clostridium difficile Infection

2015 ◽  
Vol 59 (11) ◽  
pp. 7007-7010 ◽  
Author(s):  
Jason C. Gallagher ◽  
Joseph P. Reilly ◽  
Bhagyashri Navalkele ◽  
Gemma Downham ◽  
Kevin Haynes ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Treated Patient ◽  
Hospital Costs ◽  
Antibiotic Use ◽  
Economic Benefits ◽  
Drug Costs ◽  
Hospital Charges ◽  
Oral Vancomycin ◽  
Content Type ◽  
Lengths Of Stay

ABSTRACTWe studied the clinical and economic impact of a protocol encouraging the use of fidaxomicin as a first-line drug for treatment ofClostridium difficileinfection (CDI) in patients hospitalized during a 2-year period. This study evaluated patients who received oral vancomycin or fidaxomicin for the treatment of CDI during a 2-year period. All included patients were eligible for administration of fidaxomicin via a protocol that encouraged its use for selected patients. The primary clinical endpoint was 90-day readmission with a diagnosis of CDI. Hospital charges and insurance reimbursements for readmissions were calculated along with the cost of CDI therapy to estimate the financial impact of the choice of therapy. Recurrences were seen in 10/49 (20.4%) fidaxomicin patients and 19/46 (41.3%) vancomycin patients (P= 0.027). In a multivariate analysis that included determinations of severity of CDI, serum creatinine increases, and concomitant antibiotic use, only fidaxomicin was significantly associated with decreased recurrence (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.12 to 0.93). The total lengths of stay of readmitted patients were 183 days for vancomycin and 87 days for fidaxomicin, with costs of $454,800 and $196,200, respectively. Readmissions for CDI were reimbursed on the basis of the severity of CDI, totaling $151,136 for vancomycin and $107,176 for fidaxomicin. Fidaxomicin drug costs totaled $62,112, and vancomycin drug costs were $6,646. We calculated that the hospital lost an average of $3,286 per fidaxomicin-treated patient and $6,333 per vancomycin-treated patient, thus saving $3,047 per patient with fidaxomicin. Fidaxomicin use for CDI treatment prevented readmission and decreased hospital costs compared to use of oral vancomycin.

scholarly journals Antibiotics for Treatment of Clostridium difficile Infection in Hospitalized Patients with Inflammatory Bowel Disease

2014 ◽  
Vol 58 (9) ◽  
pp. 5054-5059 ◽  
Author(s):  
Henry A. Horton ◽  
Seper Dezfoli ◽  
Dror Berel ◽  
Julianna Hirsch ◽  
Andrew Ippoliti ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Clostridium Difficile ◽  
Length Of Stay ◽  
Bowel Disease ◽  
Standard Of Care ◽  
Inclusion Criteria ◽  
Content Type ◽  
Lengths Of Stay ◽  
Inflammatory Bowel

ABSTRACTPatients with inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD), have worse outcomes withClostridium difficileinfection (CDI), including increased readmissions, colectomy, and death. Oral vancomycin is recommended for the treatment of severe CDI, while metronidazole is the standard of care for nonsevere infection. We aimed to assess treatment outcomes of CDI in IBD. We conducted a retrospective observational study of inpatients with CDI and IBD from January 2006 through December 2010. CDI severity was assessed using published criteria. Outcomes included readmission for CDI within 30 days and 12 weeks, length of stay, colectomy, and death. A total of 114 patients met inclusion criteria (UC, 62; CD, 52). Thirty-day readmissions were more common among UC than CD patients (24.2% versus 9.6%;P= 0.04). Same-admission colectomy occurred in 27.4% of UC patients and 0% of CD patients (P< 0.01). Severe CDI was more common among UC than CD patients (32.2% versus 19.4%;P= 0.12) but not statistically significant. Two patients died from CDI-associated complications (UC, 1; CD, 1). Patients with UC and nonsevere CDI had fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen compared to those treated with metronidazole (30-day readmissions, 31.0% versus 0% [P= 0.04]; length of stay, 13.62 days versus 6.38 days [P= 0.02]). Patients with UC and nonsevere CDI have fewer readmissions and shorter lengths of stay when treated with a vancomycin-containing regimen relative to those treated with metronidazole alone. Patients with ulcerative colitis and CDI should be treated with vancomycin.

Impact of coexisting pneumonia in the patients admitted with Clostridium difficile infection: a retrospective study from a national inpatient database

2021 ◽  
pp. jim-2021-001820
Author(s):  
Asim Kichloo ◽  
Zain El-Amir ◽  
Dushyant Singh Dahiya ◽  
Jagmeet Singh ◽  
Dhanshree Solanki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Antibiotic Use ◽  
Hospital Charges ◽  
Inpatient Setting ◽  
Antibiotic Administration ◽  
The Impact

Clostridium difficile is a gram-positive anaerobic spore forming bacillus that can cause infection in a setting of antibiotic use. Pneumonia is a major cause of morbidity and mortality in an inpatient setting and is frequently associated with significant antibiotic administration. This study aims to compare the outcomes of C. difficile infection (CDI) with and without pneumonia to determine the impact of pneumonia in hospitalized patients with CDI. This population-based retrospective observational propensity matched analysis study uses data from the National Inpatient Sample database for the years 2016 and 2017. The primary outcomes were in-hospital mortality, total hospital charges, and mean length of stay. Secondary outcomes were the rates of sepsis, septic shock, non-ST elevation myocardial infarction (NSTEMI), acute renal failure, deep vein thrombosis, and pulmonary embolism. In-hospital mortality was noted to be higher in patients with pneumonia than those without (6.5% vs 1.2%, adjusted OR (aOR) 3.85; 95% CI 2.90 to 5.11, p<0.001). The following outcomes were more prevalent in patients with pneumonia compared with those without pneumonia: sepsis (9.8% vs 1.8%, aOR 4.69, 95% CI 3.73 to 5.87, p<0.001), septic shock (4.0% vs 0.5%, aOR 6.32, 95% CI 4.43 to 9.03, p<0.001), NSTEMI (1.9% vs 0.5%, aOR 2.95, 95% CI 1.85 to 4.71, p<0.001), and acute renal failure (31.5% vs 23.1%, aOR 1.23, 95% CI 1.07 to 1.40, p=0.003). In conclusion, patients with pneumonia were associated with significantly higher rates of system-based complications and higher in-hospital mortality rates.

scholarly journals A Novel Agent Effective against Clostridium difficile Infection

2011 ◽  
Vol 56 (3) ◽  
pp. 1624-1626 ◽  
Author(s):  
Sofya Dvoskin ◽  
Wei-Chu Xu ◽  
Neal C. Brown ◽  
Ivan B. Yanachkov ◽  
Milka Yanachkova ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Dna Polymerase ◽  
Clostridium Difficile Infection ◽  
Human Disease ◽  
Oral Vancomycin ◽  
Hamster Model ◽  
Content Type ◽  
Novel Agent

ABSTRACTN2-(3,4-Dichlorobenzyl)-7-(2-[1-morpholinyl]ethyl)guanine (MorE-DCBG, 362E) is a synthetic purine that selectively inhibits the replication-specific DNA polymerase ofClostridium difficile. MorE-DCBG and its analogs strongly inhibited the growth of a wide variety ofC. difficilestrains. When administered orally in a hamster model ofC. difficile-specific colitis, 362E was as effective as oral vancomycin, the current agent of choice for treating severe forms of the human disease.

scholarly journals Age-Stratified Treatment Response Rates in Hospitalized Patients with Clostridium difficile Infection Treated with Metronidazole

2015 ◽  
Vol 59 (10) ◽  
pp. 6113-6116 ◽  
Author(s):  
Vy P. Pham ◽  
Andrea M. Luce ◽  
Sara C. Ruppelt ◽  
Wenjing Wei ◽  
Samuel L. Aitken ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Treatment Response ◽  
Severity Of Illness ◽  
Response Rates ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Multicenter Cohort Study ◽  
Content Type ◽  
Hospitalized Elderly ◽  
Age Related

ABSTRACTConsensus on the optimal treatment ofClostridium difficileinfection (CDI) is rapidly changing. Treatment with metronidazole has been associated with increased clinical failure rates; however, the reasons for this are unclear. The purpose of this study was to assess age-related treatment response rates in hospitalized patients with CDI treated with metronidazole. This was a retrospective, multicenter cohort study of hospitalized patients with CDI. Patients were assessed for refractory CDI, defined as persistent diarrhea after 7 days of metronidazole therapy, and stratified by age and clinical characteristics. A total of 242 individuals, aged 60 ± 18 years (Charlson comorbidity index, 3.8 ± 2.4; Horn's index, 1.7 ± 1.0) were included. One hundred twenty-eight patients (53%) had severe CDI. Seventy patients (29%) had refractory CDI, a percentage that increased from 22% to 28% and to 37% for patients aged less than 50 years, for patients from 50 to 70 years, and for patients aged >70 years, respectively (P= 0.05). In multivariate analysis, Horn's index (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.50 to 2.77;P< 0.001), severe CDI (OR, 2.25; 95% CI, 1.15 to 4.41;P= 0.018), and continued use of antibiotics (OR, 2.65; 95% CI, 1.30 to 5.39;P= 0.0072) were identified as significant predictors of refractory CDI. Age was not identified as an independent risk factor for refractory CDI. Therefore, hospitalized elderly patients with CDI treated with metronidazole had increased refractory CDI rates likely due to increased underlying severity of illness, severity of CDI, and concomitant antibiotic use. These results may help identify patients that may benefit from alternativeC. difficiletreatments other than metronidazole.

scholarly journals Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

2014 ◽  
Vol 58 (9) ◽  
pp. 5079-5083 ◽  
Author(s):  
Judith Maria Wenisch ◽  
Susanne Equiluz-Bruck ◽  
Marta Fudel ◽  
Ingun Reiter ◽  
Andrea Schmid ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Period 2 ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Mean

ABSTRACTClostridium difficileinfections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (± standard error of the mean [SEM]) of 1,038 ± 109 DDD per month (period 1) to 42 ± 10 DDD per month (period 2) (P= 0.0045). Total antibiotic use was not affected. The mean (±SEM) numbers of CDI cases in period 1 were 59 ± 3 per month and in period 2 were 32 ± 3 per month (46% reduction;P= 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.

scholarly journals Oral Vancomycin Is Highly Effective in Preventing Clostridium Difficile infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2225-2225 ◽  
Author(s):  
Alex Ganetsky ◽  
Jennifer H Han ◽  
Mitchell E Hughes ◽  
Daria V. Babushok ◽  
Noelle V Frey ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Research Funding ◽  
Antibiotic Use ◽  
Oral Vancomycin ◽  
Broad Spectrum Antibiotic ◽  
Myeloablative Conditioning ◽  
Hematopoietic Stem

Abstract Introduction: Infection remains a leading cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (alloHCT). Among the most common infectious complications in alloHCT recipients is Clostridium difficile infection (CDI), a healthcare-associated, toxin-mediated diarrheal disease occurring in up to 30% of alloHCT recipients. We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients. Methods: We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin compared to no prophylaxis in 105 consecutive adults undergoing alloHCT at the University of Pennsylvania between April 2015 and July 2016. We initiated a pilot program of CDI prophylaxis with oral vancomycin for all alloHCT recipients starting in December 2015 (N=50). Patients received oral vancomycin 125 mg twice daily starting on the day of inpatient admission for alloHCT and continued until day of discharge. Prior to the initiation of this pilot, pharmacologic prophylaxis for CDI was not administered (control arm; N=55). Testing for C. difficile in patients with diarrhea was performed using an immunoassay for glutamate dehydrogenase and toxins A and B. Indeterminate results were confirmed by a molecular assay. Control and intervention patients were characterized by potential risk factors for CDI, including demographics, prior CDI, and recent broad-spectrum antibiotic use. Continuous variables were compared using the Wilcoxon rank-sum test, and categorical variables were compared using the χ2 or Fisher exact test. The primary outcome of interest was the incidence of CDI from inpatient admission for alloHCT to discharge. Results: The rate of recent broad-spectrum antibiotic use was significantly greater in the patients that received oral vancomycin prophylaxis compared to control patients (84.0% vs. 67.2; P=0.047). In addition, more patients in the vancomycin prophylaxis group received myeloablative conditioning (62.0% vs. 45.4%; P=0.09). There were no other significant differences in patient and transplant characteristics between the intervention and control groups, including mean age (54.3 vs. 56.4 years; P=0.6), myeloid malignancy (80.0% vs. 81.8%; P=0.8) and history of CDI in the prior year (22.0% vs. 9.0%; P=0.1). There were no cases of CDI in patients that received oral vancomycin prophylaxis (0/50; 0%) whereas 11/55 (20%) patients who did not receive vancomycin prophylaxis developed CDI during alloHCT (P=<0.001). The median (interquartile range) time to CDI diagnosis was 8 days (6 - 12). The median length of stay was non-significantly longer in the intervention patients (33.5 vs. 28.0 days; P=0.06), possibly due to the higher number of myeloablative conditioning transplants in the prophylactic vancomycin group. There were no cases of vancomycin-resistant enterococcus bloodstream infection in patients who received vancomycin prophylaxis. Conclusion: Prophylactic vancomycin is highly effective in preventing CDI in alloHCT recipients. Since CDI and/or its treatment may alter the gut microbiome, longer follow up will determine if there is any impact on other outcomes. Six month follow-up data for graft-versus-host disease and overall survival will be presented. Disclosures Frey: Novartis: Research Funding; Amgen: Consultancy; Servier: Consultancy. Gill:Novartis: Patents & Royalties, Research Funding. Hexner:Novartis: Research Funding; Blueprint medicines: Consultancy. Mangan:Incyte: Other: Advisory Board; Novartis: Research Funding. Porter:Novartis: Patents & Royalties, Research Funding; Genentech: Employment.

scholarly journals Strategies for Optimizing the Diagnostic Predictive Value of Clostridium difficile Molecular Diagnostics

2017 ◽  
Vol 55 (5) ◽  
pp. 1244-1248 ◽  
Author(s):  
Larry K. Kociolek
Keyword(s):  
Clostridium Difficile ◽  
Predictive Value ◽  
Clinical Microbiology ◽  
Nucleic Acid Amplification ◽  
Oral Vancomycin ◽  
Content Type ◽  
Clinical Bioinformatics ◽  
Laxative Use ◽  
Low Probability ◽  
Clinically Significant

ABSTRACT Because nucleic acid amplification tests (NAATs) do not distinguish Clostridium difficile infection (CDI) and asymptomatic C. difficile carriage, the diagnostic predictive value of NAATs is limited when used in patients with a low probability of CDI. In this issue of the Journal of Clinical Microbiology , Truong et al. (J. Clin. Microbiol., 55:1276–1284, 2017, https://doi.org/10.1128/JCM.02319-16 ) report significant reductions in hospital-onset CDI and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinical bioinformatics resources to prevent C. difficile testing of stools from patients without clinically significant diarrhea and in patients with recent laxative use.

scholarly journals Extended-Infusion Cefepime Reduces Mortality in Patients with Pseudomonas aeruginosa Infections

2013 ◽  
Vol 57 (7) ◽  
pp. 2907-2912 ◽  
Author(s):  
Karri A. Bauer ◽  
Jessica E. West ◽  
James M. O'Brien ◽  
Debra A. Goff
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Length Of Stay ◽  
Hospital Costs ◽  
Economic Benefits ◽  
Content Type ◽  
Single Center Study ◽  
The Mean ◽  
Extended Infusion ◽  
Center Study ◽  
Overall Mortality

ABSTRACTIn an era of escalating resistance and a lack of new antimicrobial discovery, stewardship programs must utilize knowledge of pharmacodynamics to achieve maximal exposure in the treatment ofPseudomonas aeruginosainfections. We evaluated the clinical and economic outcomes associated with extended-infusion cefepime in the treatment ofP. aeruginosainfections. This single-center study compared inpatients who received cefepime for bacteremia and/or pneumonia admitted from 1 January 2008 through 30 June 2010 (a 30-min infusion of 2 g every 8 h) to those admitted from 1 July 2010 through 31 May 2011 (a 4-h infusion of 2 g every 8 h). The overall mortality was significantly lower in the group that received extended-infusion treatment (20% versus 3%;P= 0.03). The mean length of stay was 3.5 days less for patients who received extended infusion (P= 0.36), and for patients admitted to the intensive care unit the mean length of stay was significantly less in the extended-infusion group (18.5 days versus 8 days;P= 0.04). Hospital costs were $23,183 less per patient, favoring the extended-infusion treatment group (P= 0.13). We conclude that extended-infusion treatment with cefepime provides increased clinical and economic benefits in the treatment of invasiveP. aeruginosainfections.

scholarly journals Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

2017 ◽  
Vol 55 (5) ◽  
pp. 1276-1284 ◽  
Author(s):  
Cynthia Y. Truong ◽  
Saurabh Gombar ◽  
Richard Wilson ◽  
Gopalakrishnan Sundararajan ◽  
Natasa Tekic ◽  
...  
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Real Time ◽  
Complication Rates ◽  
Clinical Testing ◽  
Oral Vancomycin ◽  
Content Type ◽  
Days Of Therapy ◽  
Data Tracking ◽  
Testing Criteria

ABSTRACT Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days ( P < 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days ( P = 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days ( P = 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Real-time electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.

scholarly journals Risk Factors for Acquisition and Loss of Clostridium difficile Colonization in Hospitalized Patients

2015 ◽  
Vol 59 (8) ◽  
pp. 4533-4543 ◽  
Author(s):  
Erik R. Dubberke ◽  
Kimberly A. Reske ◽  
Sondra Seiler ◽  
Tiffany Hink ◽  
Jennie H. Kwon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Clinical Laboratory ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Care Hospital ◽  
Content Type ◽  
Content Acquisition ◽  
Stool Samples

ABSTRACTAsymptomatic colonization may contribute toClostridium difficiletransmission. Few data identify which patients are at risk for colonization. We performed a prospective cohort study ofC. difficilecolonization and risk factors forC. difficileacquisition and loss in hospitalized patients. Patients admitted to medical or surgical wards at a tertiary care hospital were enrolled; interviews and chart review were performed to determine patient demographics,C. difficileinfection (CDI) history, medications, and health care exposures. Stool samples/rectal swabs were collected at enrollment and discharge; stool samples from clinical laboratory tests were also included. Samples were cultured forC. difficile, and the isolates were tested for toxins A and B and ribotyped. Chi-square tests and univariate logistic regression were used for the analyses. Two hundred thirty-five patients were enrolled. Of the patients, 21% were colonized withC. difficile(toxigenic and nontoxigenic) at admission and 24% at discharge. Ribotype 027 accounted for 6% of the strains at admission and 12% at discharge. Of the patients colonized at admission, 78% were also colonized at discharge. Cephalosporin use was associated withC. difficileacquisition (47% of patients who acquiredC. difficileversus 25% of patients who did not;P= 0.03). β-lactam–β-lactamase inhibitor combinations were associated with a loss ofC. difficilecolonization (36% of patients who lostC. difficilecolonization versus 8% of patients colonized at both admission and discharge;P= 0.04), as was metronidazole (27% versus 3%;P= 0.03). Antibiotic use affects the epidemiology of asymptomaticC. difficilecolonization, including acquisition and loss, and it requires additional study.

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