PP022-SUN PREVENTION OF CLOSTRIDIUM DIFFICILE-ASOCCIATED DIARRHEA BY COMPREHENSIVE NUTRITIONAL SUPPORT PROTOCOL WITH RESTRICTION OF BROAD SPECTRUM-ANTIBIOTICS USE

2013 ◽  
Vol 32 ◽  
pp. S29
Author(s):  
T. Sato ◽  
S. Kushimoto
Keyword(s):  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Nutritional Support ◽  
Broad Spectrum Antibiotics ◽  
Antibiotics Use

scholarly journals 2422. Effectiveness of a Probiotic for Primary Prevention of Clostridium difficile Infection and Antibiotic-Associated Diarrhea among Hospitalized Patients Receiving Broad-Spectrum Antibiotics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S836-S837
Author(s):  
Khanh-Linh Le ◽  
Heather Young ◽  
Timothy C Jenkins ◽  
Robert Tapia ◽  
Katherine C Shihadeh
Keyword(s):  
Primary Prevention ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Hospitalized Patients ◽  
Broad Spectrum Antibiotic ◽  
Probiotic Group ◽  
Broad Spectrum Antibiotics ◽  
Days Of Therapy ◽  
Antibiotic Associated Diarrhea

Abstract Background Prior to 2016, Denver Health Medical Center had a higher-than-expected rate of hospital onset Clostridium difficile infection (HO-CDI). A multifaceted CDI prevention plan was implemented, including the use of a probiotic as primary prevention for HO-CDI and antibiotic-associated diarrhea (AAD) in inpatients receiving broad-spectrum antibiotics. We aimed to study the effectiveness of probiotic use in this clinical context. Methods During the intervention, inpatient orders for a broad-spectrum antibiotic triggered a best practice advisory recommending once daily co-administration of 100 billion units of a probiotic containing Lactobacillus casei, L. rhamnosus, and L. acidophilus (BioK+ ®). To evaluate effectiveness and safety of this intervention, we performed a retrospective cohort study including adult inpatients who received > 24 hours of a broad-spectrum antibiotic between April 2016 and March 2018. The primary endpoint was the incidence of HO-CDI (> 3 days after admission) compared between patients who received antibiotics alone vs. antibiotics plus the probiotic. Secondary endpoints were the incidence of AAD, defined as a negative CDI test after antibiotic initiation, and the incidence of Lactobacillus species identified in clinical cultures. Results 3,291 patients were included; 1,835 received antibiotics alone and 1,456 received antibiotics plus the probiotic. Baseline characteristics between groups were similar, except patients in the antibiotic alone group had a greater incidence of cirrhosis and proton-pump inhibitor use (16.1% vs 10.1%, P < 0.001; 39.1% vs 31.5%, P < 0.001). Length of stay and antibiotic days of therapy were longer in the antibiotic plus probiotic group [6 days (IQR, 3–11) vs 6 days (IQR, 4–12), P = 0.014; 4 days (IQR, 3–7) vs 5 days (IQR, 3–7), P < 0.001]. The incidence of HO-CDI (37, 2% vs 35, 2.4%; P = 0.450) and AAD (231, 12.6% vs 199, 13.7%; P = 0.362) were similar between groups. Lactobacillus was identified in at least one clinical culture from 0.2% (3/1835) and 0.3% (4/1456) of patients in the antibiotic alone group and antibiotic plus probiotic group, respectively (P = 0.497). Conclusion In hospitalized patients receiving broad-spectrum antibiotics, co-administration of a probiotic did not appear to reduce the incidence of HO-CDI or AAD. Disclosures All authors: No reported disclosures.

scholarly journals 2420. Reduced hospital-onset Clostridium difficile infection incidence following Saccharomyces boulardii co-administration with broad-spectrum antibiotics during hospitalization.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S835-S836
Author(s):  
Eric Wombwell ◽  
Mark E Patterson ◽  
Bridget Bransteitter ◽  
Lisa Gillen
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Hospital Admissions ◽  
Group Analysis ◽  
Probiotic Strain ◽  
Saccharomyces Boulardii ◽  
Protective Effects ◽  
Convenience Sample ◽  
Broad Spectrum Antibiotics

Abstract Background Conflicting evidence in smaller randomized trials and meta-analyses regarding the protective effects of probiotics against Clostridium difficile infection underscore the need for further study. Our objective was to evaluate the effect of a single probiotic strain, Saccharomyces boulardii, at a standardized dose on hospital-onset C. difficile (HO-CDI) rates within hospitalizations administered broad-spectrum antibiotics. Methods Retrospective cohort study merging hospital prescribing data with C. difficile case data from the National Health Safety Network at a 220-bed level-2 trauma center nonacademic hospital. A convenience sample of 8,763 hospital admissions administrated at least one dose of a fluoroquinolone, clindamycin, or β-lactam class antibiotic during hospitalization was assessed. Hospitalizations were categorized by whether antibiotics were administered alone (control) or in conjunction with S. boulardii 20 billion colony-forming units daily (intervention). Associations between S. boulardii administration and HO-CDI incidence was evaluated by multivariate logistic regression. A sub-group analysis evaluated the extent to which administering S. boulardii within or after 24-hours of antibiotic start changed the effect. Propensity scores incorporated to account for selection bias. Results Hospitalizations where S. boulardii was co-administered with antibiotics had a reduced likelihood of HO-CDI (OR = 0.56, 95% CI 0.32 – 0.93) compared with control hospitalizations. S. boulardii administered within 24-hours of antibiotic start had a reduced likelihood of HO-CDI (OR = 0.40, 95% CI 0.21 – 0.75). No effect observed if S. boulardii administered after 24-hours (OR = 0.86, 95% CI 0.45 – 1.64). Post-hoc analysis for disease latency, the average number of days to HO-CDI onset was 5.6, 6.4, and 8.0 days for antibiotic only, S. boulardii after 24-hours, and S. boulardii within 24-hours of antibiotic, respectively (P < 0.04). Conclusion Co-administering S. boulardii with broad-spectrum antibiotics is associated with a reduced risk of C. difficile in hospitalized patients, especially if started within 24-hours of antibiotic initiation. S. boulardii should be considered as preventative intervention to reduce the risk of HO-CDI. Disclosures All authors: No reported disclosures.

scholarly journals 1033. Thinking Outside the Bowel: Clostridium difficile Bacteremia Case Series

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S308-S308 ◽  
Author(s):  
Adam Pettigrew ◽  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Jose Montero ◽  
Sandra Gompf ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clostridium Difficile ◽  
Bloodstream Infection ◽  
Broad Spectrum ◽  
Case Series ◽  
Prior History ◽  
Broad Spectrum Antibiotics ◽  
History Of ◽  
Polymicrobial Bacteremia ◽  
Hospital Acquired

Abstract Background While Clostridium difficile gastrointestinal infection (CDI) is the most common hospital-acquired infectious disease, C. difficile bacteremia (CDB) is exceedingly rare and its risk factors, mortality rate, and modalities of treatment are not well defined. Methods We conducted a retrospective, IRB approved, chart review of adult patients with a diagnosis of CDB admitted to our institutions from 2011 through 2017. Variables catalogued included previous antibiotic and proton pump inhibitor (PPI) use, co-morbid conditions, prior history of CDI, diarrhea at the time of CDB, active malignancy, and gastrointestinal (GI) disruption (e.g., perforated viscous, GI bleeding, abdominal malignancy). Treatment courses and outcomes for CDB were also gleaned. Results Seven patients with CDB were identified, with ages ranging from 35 to 81 years (median 65 years). Six (85.7%) patients had evidence of GI disruption and three (42.9%) were noted to have active cancer. Three (42.9%) patients had previous CDI by testing and three (42.9%) had complaints of diarrhea at the time of diagnosis. Six (85.7%) patients had exposure to PPIs before CDB diagnosis, and five (71.4%) had prior antibiotic exposure in the past 30 days. Five (71.4%) patients had a polymicrobial bloodstream infection, with the majority of organisms being enteric in nature. In terms of CDB treatment, the majority of patients received intravenous (IV) metronidazole and/or IV vancomycin in addition to broad-spectrum antibiotics due to the polymicrobial nature of their infection. Three (42.9%) patients died during their hospitalization, only one who had polymicrobial bacteremia. Conclusion CDI is the most common cause of hospital acquired infection, although rarely causes bacteremia. Notable findings in our population included older age, concomitant malignancy, evidence of GI disruption, and prior exposure to PPIs and antibiotics. Antibiotics chosen to treat CDB were IV metronidazole and/or IV vancomycin, with other broad-spectrum antibiotics utilized due to polymicrobial bacteremia. CDB is associated with a high mortality rate and is commonly manifested as a polymicrobial bloodstream infection. This is one of the larger case series that adds to the scant literature characterizing patients diagnosed with CDB. Disclosures All authors: No reported disclosures.

Excess risk of Clostridium difficile enterocolitis in ovarian cancer is related to exposure to broad-spectrum antibiotics

2013 ◽  
Vol 130 (1) ◽  
pp. e63-e64
Author(s):  
J. Kim ◽  
K. Ward ◽  
N. Shah ◽  
C. Saenz ◽  
M. McHale ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Excess Risk ◽  
Broad Spectrum Antibiotics

scholarly journals Clostridium difficile infection in an academic medical center in Saudi Arabia: prevalence and risk factors

2020 ◽  
Vol 40 (4) ◽  
pp. 305-309
Author(s):  
Mai Alalawi ◽  
Seba Aljahdali ◽  
Bashaer Alharbi ◽  
Lana Fagih ◽  
Raghad Fatani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Medical Center ◽  
Academic Medical Center ◽  
Infection Prevalence ◽  
Healthcare Facilities ◽  
Broad Spectrum Antibiotics ◽  
Academic Medical ◽  
Significant Difference

ABSTRACT BACKGROUND: Clostridium difficile infection is one of the most common causes of diarrhea in healthcare facilities. More studies are needed to identify patients at high risk of C difficile infection in our community. OBJECTIVES: Estimate the prevalence of C difficile infection among adult patients and evaluate the risk factors associated with infection. DESIGN: Retrospective record review. SETTING: Tertiary academic medical center in Jeddah. PATIENTS AND METHODS: Eligible patients were adults (≥18 years old) with confirmed C difficile diagnosis between January 2013 and May 2018. MAIN OUTCOME MEASURES: Prevalence rate and types of risk factors. SAMPLE SIZE: Of 1886 records, 129 patients had positive lab results and met the inclusion criteria. RESULTS: The prevalence of C difficile infection in our center over five years was 6.8%. The mean (SD) age was 56 (18) years, and infection was more prevalent in men (53.5%) than in women (46.5%). The most common risk factors were use of proton-pump inhibitors (PPI) and broad-spectrum antibiotics. The overlapping exposure of both PPIs and broad-spectrum antibiotics was 56.6%. There was no statistically significant difference between the type of PPI ( P =.254) or antibiotic ( P =.789) and the onset of C difficile infection. CONCLUSION: The overall C difficile infection prevalence in our population was low compared to Western countries. The majority of the patients who developed C difficile infection were using PPIs and/or antibiotics. No differences were observed in the type of antibiotic or PPI and the onset of C difficile infection development. Appropriate prescribing protocols for PPIs and antibiotics in acute settings are needed. LIMITATIONS: Single center and retrospective design. CONFLICT OF INTEREST: None.

Excess risk of Clostridium difficile infection in ovarian cancer is related to exposure to broad-spectrum antibiotics

2013 ◽  
Vol 21 (11) ◽  
pp. 3103-3107 ◽  
Author(s):  
Josephine S. Kim ◽  
Kristy K. Ward ◽  
Nina R. Shah ◽  
Cheryl C. Saenz ◽  
Michael T. McHale ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Excess Risk ◽  
Broad Spectrum Antibiotics

Saccharomyces boulardii for the Prevention of Hospital Onset Clostridium difficile Infection

2015 ◽  
Vol 24 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Elizabeth A. Flatley ◽  
Ashley M. Wilde ◽  
Michael D. Nailor
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Saccharomyces Boulardii ◽  
Control Group ◽  
Hospital Formulary ◽  
Broad Spectrum Antibiotics ◽  
Order Set

Background & Aims: Probiotics, including Saccharomyces boulardii, have been advocated for the prevention of Clostridium difficile infection. The aim of this project was to evaluate the effects of the removal of S. boulardii from an automatic antibiotic order set and hospital formulary on hospital onset C. difficile infection rates.Method. Design: A retrospective chart review was performed on all patients with hospital onset C. difficile infection during the 13 months prior (control group) and the 13 months after (study group) removal of an automatic order set linking S. boulardii capsules to certain broad spectrum antibiotics. Setting: A large 800+ bed tertiary hospitalResults: Among all hospitalized patients, the rate of hospital onset C. difficile infection was 0.99 per 1000 patient days while the S. boulardii protocol was active compared with 1.04 per 1000 patient days (p=0.10) after S. boulardii was removed from the formulary. No difference in the rate of hospital onset C. difficile infection was detected in patients receiving the linked broad spectrum antibiotics during and after the removal of the protocol (1.25% vs. 1.51%, respectively; p=0.70).Conclusions: Removal of S. boulardii administration to patients receiving broad spectrum antibiotics and the hospital formulary did not impact the rate of hospital onset C. difficile infection in either the hospital population or patients receiving broad spectrum antibiotics.

scholarly journals A Rare Case of Pseudomembranous Colitis Presenting with Pleural Effusion and Ascites with Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Hossain Salehi ◽  
Amir Mohammad Salehi
Keyword(s):  
Pleural Effusion ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Broad Spectrum ◽  
Orthopedic Surgery ◽  
Rare Case ◽  
Pseudomembranous Colitis ◽  
Broad Spectrum Antibiotics ◽  
History Of

Clostridium difficile infection usually results from long-term and irregular antibiotic intake. The high-risk individuals for this infection include the patients undergoing chemotherapy due to malignancy, immunocompromised patients, and hospitalized patients receiving broad-spectrum antibiotics. The most common clinical manifestation of Clostridium difficile infection is diarrhea. However, pleural effusion and ascites have rarely been observed. As mentioned, these manifestations can be developed in a patient being treated with broad-spectrum antibiotics. Therefore, the present study reports a rare case of Clostridium difficile infection manifesting with these rare manifestations who was a 78-year-old female patient with a history of COVID-19, orthopedic surgery, and antibiotic treatment with cefixime and gentamicin.

scholarly journals Clostridium difficilePeritonitis: An Emerging Infection in Peritoneal Dialysis Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Saira Chaughtai ◽  
Bhavika Gandhi ◽  
Zeeshan Chaughtai ◽  
Dana Tarina ◽  
Mohammad A. Hossain ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Broad Spectrum ◽  
Close Association ◽  
Enteric Bacteria ◽  
Dialysis Patients ◽  
Broad Spectrum Antibiotics ◽  
Antibiotics Use ◽  
Immunocompromised State ◽  
Inappropriate Antibiotics ◽  
Stool Analysis

Recently, the incidence ofClostridium difficile-(C. difficile-) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developedC.difficileexperienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity.C.difficileinfection in peritoneal dialysis patients is problematic from two aspects: (1) because dialysis patients are immunocompromised, the infection can be devastating and (2) infection directly interferes with their renal replacement therapy. In this article, we present a case of peritoneal dialysis (PD)-related peritonitis caused byC. difficile-associated diarrhea and colitis. In this patient, the peritonitis was caused by transmural translocation of the enteric bacteria. While the peritoneal fluid culture did not grow the organism (possibly because of prior empiric broad-spectrum antibiotics use), the positive PCR on stool analysis suggestedC. difficile-related peritonitis, along with the rapid clinical improvement induced byC.difficile-directed therapy (metronidazole) and discontinuation of broad-spectrum antibiotics. The patient was successfully treated with metronidazole without PD catheter removal.C.difficileinfection is common and frequently internists are the first contact with such patients. This article highlightsC.difficileinfection in a PD patient and raises awareness of this infection in dialysis patients.

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