scholarly journals Healthcare provider diagnostic testing practices for identification of Clostridioides (Clostridium) difficile in children: an Emerging Infections Network survey

2019 ◽  
Vol 40 (3) ◽  
pp. 276-280 ◽  
Author(s):  
Larry K. Kociolek ◽  
Preeta K. Kutty ◽  
Philip M. Polgreen ◽  
Susan E. Beekmann
Keyword(s):  
Clostridium Difficile ◽  
Infectious Diseases ◽  
Healthcare Provider ◽  
Neonatal Intensive Care ◽  
Diagnostic Testing ◽  
Emerging Infections ◽  
Electronic Survey ◽  
Testing Practices ◽  
E Mail ◽  
Infants And Young Children

AbstractObjective:To characterize healthcare provider diagnostic testing practices for identifying Clostridioides (Clostridium) difficile infection (CDI) and asymptomatic carriage in children.Design:Electronic survey.Methods:An 11-question survey was sent by e-mail or facsimile to all pediatric infectious diseases (PID) members of the Infectious Diseases Society of America’s Emerging Infections Network (EIN).Results:Among 345 eligible respondents who had ever responded to an EIN survey, 196 (57%) responded; 162 of these (83%) were aware of their institutional policies for CDI testing and management. Also, 159 (98%) respondents knew their institution’s C. difficile testing method: 99 (62%) utilize NAAT without toxin testing and 60 (38%) utilize toxin testing, either as a single test or a multistep algorithm. Of 153 respondents, 10 (7%) reported that formed stools were tested for C. difficile at their institution, and 76 of 151 (50%) reported that their institution does not restrict C. difficile testing in infants and young children. The frequency of symptom- and age-based testing restrictions did not vary between institutions utilizing NAAT alone compared to those utilizing toxin testing for C. difficile diagnosis. Of 143 respondents, 26 (16%) permit testing of neonatal intensive care unit patients and 12 of 26 (46%) treat CDI with antibiotics in this patient population.Conclusions:These data suggest that there are opportunities to improve CDI diagnostic stewardship practices in children, including among hospitals using NAATs alone for CDI diagnosis in children.

scholarly journals Infective Endocarditis Guidelines: The Challenges of Adherence—A Survey of Infectious Diseases Clinicians

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Glen Huang ◽  
Siddhi Gupta ◽  
Kyle A Davis ◽  
Erin W Barnes ◽  
Susan E Beekmann ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infective Endocarditis ◽  
Infectious Diseases ◽  
Valve Replacement ◽  
Antimicrobial Therapy ◽  
Prosthetic Valve ◽  
Blood Cultures ◽  
Emerging Infections ◽  
Electronic Survey ◽  
Aminoglycoside Therapy

Abstract Background Guidelines exist to aid clinicians in managing patients with infective endocarditis (IE), but the degree of adherence with guidelines by Infectious Disease (ID) physicians is largely unknown. Methods An electronic survey assessing adherence with selected IE guidelines was emailed to 1409 adult ID physician members of the Infectious Diseases Society of America’s Emerging Infections Network. Results Five hundred fifty-seven physicians who managed IE responded. Twenty percent indicated that ID was not consulted on every case of IE at their hospitals, and 13% did not recommend transthoracic echocardiography (TTE) for all IE cases. The duration of antimicrobial therapy was timed from the first day of negative blood cultures by 91% of respondents. Thirty-four percent of clinicians did not utilize an aminoglycoside for staphylococcal prosthetic valve IE (PVE). Double β-lactam therapy was “usually” or “almost always” employed by 83% of respondents for enterococcal IE. For patients with active IE who underwent valve replacement and manifested positive surgical cultures, 6 weeks of postoperative antibiotics was recommended by 86% of clinicians. Conclusions The finding that adherence was <90% with core guideline recommendations that all patients with suspected IE be seen by ID and that all patients undergo TTE is noteworthy. Aminoglycoside therapy of IE appears to be declining, with double β-lactam regimens emerging as the preferred treatment for enterococcal IE. The duration of postoperative antimicrobial therapy for patients undergoing valve replacement during acute IE is poorly defined and represents an area for which additional evidence is needed.

scholarly journals Diagnosis and Management of Osteomyelitis Associated With Stage 4 Pressure Ulcers: Report of a Query to the Emerging Infections Network of the Infectious Diseases Society of America

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Anjum S Kaka ◽  
Susan E Beekmann ◽  
Amy Gravely ◽  
Gregory A Filice ◽  
Philip M Polgreen ◽  
...  
Keyword(s):  
Pressure Ulcers ◽  
Response Rate ◽  
Bone Biopsy ◽  
Diagnostic Testing ◽  
Future Research ◽  
Emerging Infections ◽  
Electronic Survey ◽  
The Past ◽  
Stage 4 ◽  
Ulcer Base

Abstract Background Few studies exist to guide the management of patients with stage 4 pressure ulcers with possible underlying osteomyelitis. We hypothesized that infectious disease (ID) physicians would vary widely in their approach to such patients. Methods The Emerging Infections Network distributed a 10-question electronic survey in 2018 to 1332 adult ID physicians in different practice settings to determine their approach to such patients. Results Of the 558 respondents (response rate: 42%), 17% had managed no such patient in the past year. Of the remaining 464 respondents, 60% usually felt confident in diagnosing osteomyelitis; the strongest clinical indicator of osteomyelitis reported was palpable or visible bone at the ulcer base. Approaches to diagnosing osteomyelitis in patients with visible and palpable bone varied: 41% of respondents would assume osteomyelitis, 27% would attempt pressure off-loading first, and 22% would perform diagnostic testing immediately. Preferred tests for osteomyelitis were bone biopsy (for culture and histopathology) and magnetic resonance imaging. Respondents differed widely on favored route(s) (intravenous, oral, or both) and duration of antimicrobial therapy but would treat longer in the absence, vs presence, of full surgical debridement (P < .001). Overall, 62% of respondents opined that osteomyelitis under stage 4 pressure ulcers is usually or almost always treated excessively, and most (59%) suggested multiple topics for future research. Conclusions Regarding osteomyelitis underlying stage 4 pressure ulcers, ID physicians reported widely divergent diagnostic and treatment approaches. Most of the reported practice is not supported by the available evidence, which is quite limited and of low quality.

scholarly journals What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Coutts ◽  
Alix Woldring ◽  
Ann Pederson ◽  
Julie De Salaberry ◽  
Horacio Osiovich ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Provider ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Healthcare Providers ◽  
Neurodevelopmental Outcomes ◽  
Kangaroo Care ◽  
Optimal Care ◽  
Barriers And Enablers ◽  
Provider Beliefs

Abstract Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

An Outbreak of Clostridium difficile Necrotizing Enterocolitis

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 266-266
Author(s):  
GRAHAM W. CHANCE ◽  
VICTOR K. M. HAN
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Neonatal Intensive Care Unit ◽  
Necrotizing Enterocolitis ◽  
Neonatal Intensive Care ◽  
Colonization Rate ◽  
Control Subjects

In Reply.— The observation made by Mathew et al on the lack of relationship between the isolation of Clostridium difficile and necrotizing enterocolitis (NEC) in their neonatal intensive care unit (NICU) is interesting, although the numbers are too small for relevant comment. Importantly, no mention was made on how the control subjects were selected.1 We agree that the colonization rate in NICUs may vary widely and may range up to 55% in certain units.2 In the subsequent four months following the outbreak that we reported, all infants admitted to our NICU had their stools tested weekly for C difficile.

Analysis of the tendency of development of biosensors based on GaN

2021 ◽  
Author(s):  
S.I. Agasieva ◽  
E.A. Smetanin ◽  
A.R. Vechkanov ◽  
A.V. Gubanov
Keyword(s):  
Clinical Trials ◽  
Infectious Diseases ◽  
Diagnostic Tests ◽  
Diagnostic Testing ◽  
Healthcare Systems ◽  
Clinical Analysis ◽  
Molecular Diagnostic ◽  
Economic Damage ◽  
Disease Research ◽  
Local Healthcare

Statement of the problem of this article - one of the most important problems is protection from especially dangerous infectious diseases. The use of biosensors in clinical trials will significantly reduce the time for obtaining the results of analyzes, thereby speeding up the appointment of treatment to patients. The purpose of the article is to present modern designs of biosensors based on gallium nitride, the possibilities of their application and characteristics. Consider the principles of operation, areas of application and characteristics. As a result, the design of modern biosensors and modern trends in their use from various sources of literature in recent years are shown. Biosensors, principles of their action, areas of application and characteristics are considered, which will reduce the possible socio-economic damage from temporary disability for sick citizens due to the rapid and timely implementation of anti-epidemic measures. Practical value: the proposed biosensors are of interest as devices for detecting diseases. The use of biosensors in clinical disease research has several potential advantages over other clinical analysis methods, including increased analysis speed and flexibility, multipurpose analysis capability, automation, reduced diagnostic testing costs, and the ability to integrate molecular diagnostic tests into local healthcare systems.

scholarly journals Emerging infectious disease preparedness and response in healthcare: perspectives from COVID-19 and the role of College-Learnt Microbiology

2021 ◽  
Vol 22 (3) ◽  
pp. 312-321
Author(s):  
J. Tonui ◽  
W. Chepkutto ◽  
J. Rotich
Keyword(s):  
Health Care ◽  
Infectious Diseases ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Emerging Infectious Diseases ◽  
Microbial Pathogens ◽  
Infection Prevention And Control ◽  
Care Providers ◽  
Emerging Infections

Coronavirus disease 2019 (COVID-19) pandemic began in December 2019 in Wuhan City China where it is believed to have been transmitted to humans from an unknown animal species. The public health, social and economic impact of the pandemic world over is detrimental. Health care providers at the frontline in the fight against COVID-19 are at the greatest risk of infection and so far, many have been infected and some have already died from the disease. Thus, it is imperative that healthcare providers have adequate knowledge of infectious diseases and microbial pathogens to comprehend the scale of risk for better recognition and response. Microbiological concepts of infection prevention and control, hand hygiene and aseptic techniques are essential in slowing down the spread of the virus. COVID-19 has proven that infectious agents can emerge from any region in the world and can spread rapidly with ominous consequences to all humanity. This narrative review discusses the role of college-learnt microbiology in health care provider preparedness for emerging infectious diseases in light of the current pandemic. Keywords: Emerging; Infections; Preparedness; Response; Microbiology; COVID-19; Training

Infectious Diseases

2019 ◽  
Author(s):  
Doug Fink
Keyword(s):  
Infectious Diseases ◽  
Modern Medicine ◽  
Emerging Infections ◽  
High Resource ◽  
The World ◽  
Causes Of Mortality ◽  
And Migration ◽  
Almost All ◽  
Global And Local ◽  
Immunomodulatory Therapies

Infectious diseases are global and local. They impact health and dis­ease in every country, but protean factors— cultural, geographical, and political— determine their particular local distribution. Every single patient is globally colonized by microorganisms, but singular behaviours, genetics and co- morbidities significantly determine what organisms cause disease in any individual. The practice of infectious diseases medi­cine necessarily demands an understanding of the person and the world in which they live. This chapter will emphasize the importance of context in assessing patients for infectious diseases. In terms of global mortality, communicable diseases remain the leading causes of mortality. Despite the evocative epithet of ‘infectious diseases’, these are not all caused by creatures that creep and crawl. Cosmopolitan diseases (i.e. universally distributed infections such as influenza or bac­terial pneumonia) represent a huge burden wherever medicine is prac­tised. However, it is important to note that in high- resource settings, infection imported by travel and migration is increasing. In particular, the international traffic of emerging infections, such as Zika virus, and anti-microbial resistance (AMR) are already major healthcare problems. As the world shrinks and the climate changes, the distribution of infectious diseases will continue to change. The threat of AMR no longer looms— it is a present and real danger. In the time it will take for disciples of this text to reach the end of their specialty training, AMR will account annually for more deaths than cancer. The delivery of almost all interventional, surgical, and immunomodulatory therapies depends on our ability to provide effective anti- microbial prophylaxis and rescue. The ability of organisms to adapt rapidly to novel iatrogenic selection pressures means that the treatment of human immunodeficiency virus (HIV), tuberculosis (TB), malaria, and manifold other pathogens will be compromised, not simply anti- bacterial agents. The future of modern medicine depends on the global healthcare community sharing both concern and responsibility. This chapter will include cases pertaining to the management of AMR.

Taking on Clostridioides difficile

2021 ◽  
pp. 141-157
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Clostridium Difficile ◽  
Tract Infection ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Infection Prevention ◽  
Hospital Staff ◽  
Clostridioides Difficile

The adaptive approach used in the previous chapters to prevent catheter-associated urinary tract infection (CAUTI) is applied to an initiative to prevent Clostridioides difficile (formerly Clostridium difficile) infection. These two initiatives differ regarding their scope, the members of their teams, and the elements of their bundles. For preventing C. difficile, for example, the most important bundle item is antimicrobial stewardship since the use of broad-spectrum antibiotics vastly increases a person’s risk of becoming infected. Infectious diseases physicians or clinical pharmacists are to examine the circumstances of antimicrobial prescriptions they have filled to see whether they meet infection prevention standards; if not, the prescribing physician will receive prompt feedback. Differences aside, the basic elements of the CAUTI framework apply, from the C-suite’s decision to go ahead with the initiative to the tactics used to sell the C. difficile bundle to the hospital staff.

scholarly journals 1624. Primary Care Physician Knowledge, Attitudes, and Diagnostic Testing Practices for Norovirus and Acute Gastroenteritis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S592-S593
Author(s):  
Cristina Cardemil ◽  
Sean O’Leary ◽  
Brenda Beaty ◽  
Kathryn Ivey ◽  
Megan Lindley ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Gastroenteritis ◽  
Diagnostic Testing ◽  
Age Groups ◽  
Mail Survey ◽  
Care Physician ◽  
Knowledge Gaps ◽  
Vaccine Introduction ◽  
Physician Knowledge ◽  
Testing Practices

Abstract Background Norovirus is a leading cause of acute gastroenteritis (AGE) across the age spectrum; candidate vaccines are in clinical trials. While norovirus diagnostic testing is increasingly available, stool testing may not be performed routinely, which can hamper surveillance and burden of disease estimates. Our objectives were to understand physicians’ stool testing practices in outpatients with AGE, and physician knowledge of norovirus, in order to improve surveillance and prepare for vaccine introduction. Methods Internet and mail survey on AGE and norovirus conducted January to March 2018 among national networks of primary care pediatricians (Peds), family practice (FP) and general internal medicine (GIM) physicians. Results The response rate was 59% (820/1,383). During peak AGE season, physicians estimated they ordered stool tests for a median of 15% (interquartile range: 5–33%) of their outpatients with AGE. Stool tests were more often available for ova and parasites, Clostridioides difficile, and bacterial culture (>95% for all specialties) than for norovirus (6–33% across specialties); even when available, norovirus-specific tests were infrequently ordered. Most providers were unaware that norovirus is a leading cause of AGE across all age groups (Peds 80%, FP 86%, GIM 89%) or that alcohol-based hand sanitizers are ineffective against norovirus (Peds 51%, FP 66%, GIM 62%). Conclusion Physicians infrequently order stool tests for outpatients with AGE, and have knowledge gaps on norovirus prevalence and hand hygiene for prevention. Understanding the limitations of surveillance that relies on physician-ordered stool diagnostics, and closing physician knowledge gaps, can help support norovirus vaccine introduction. Disclosures All authors: No reported disclosures.

scholarly journals 2355. The Association Between Diagnostic Testing Method and Clostridium difficile Infection Severity

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S811-S811
Author(s):  
Anitha Menon ◽  
Donald A Perry ◽  
Jonathan Motyka ◽  
Shayna Weiner ◽  
Alexandra Standke ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Severe Disease ◽  
Diagnostic Testing ◽  
Fold Increase ◽  
Adverse Outcomes ◽  
Clinical Microbiology Laboratory ◽  
Diagnostic Strategy ◽  
Symptomatic Infection ◽  
The University

Abstract Background The optimal diagnostic strategy for Clostridium difficile infection (CDI) is not known, and no test is shown to clearly differentiate colonization from symptomatic infection. We hypothesized that detection and/or quantification of stool toxins would associate with severe disease and adverse outcomes. Methods We conducted a retrospective cohort study among subjects with CDI diagnosed in 2016 at the University of Michigan. The clinical microbiology laboratory tested for glutamate dehydrogenase antigen and toxins A/B by enzyme immunoassay (EIA). Discordant results reflexed to PCR for the tcdB gene. Stool toxin levels were quantified via a modified cell cytotoxicity assay (CCA). C. difficile was isolated by anaerobic culture and ribotyped. Severe CDI was defined by the IDSA criteria: white blood cell count >15,000 cells/µL or a 1.5-fold increase in serum creatinine above baseline. The primary outcomes were all-cause 30-day mortality and a composite of colectomy, ICU admission, and/or death attributable to CDI within 30 days. Analysis included standard bivariable tests and adjusted models via logistic regression. Results From 565 adult patients, we obtained 646 samples; 199 (30.8%) contained toxins by EIA. Toxin positivity associated with IDSA severity (Table 1), but not our primary outcomes on unadjusted analysis. After adjustment for putative confounders, we still did not observe an association between toxin positivity and our primary outcomes. Stool toxin levels by CCA >6.4 ng/mL associated with IDSA severity (Table 1), but not the primary outcomes. Compared with the period from 2010 to 2013, the circulating ribotypes of C. difficile at our institution changed in 2016. Notably ribotype 106 newly emerged, accounting for 10.6% of strains, and ribotype 027 fell to 9.3% (Table 2). The incidence of ribotype 014-027 has remained stable at 18.9%, but this strain was associated with both IDSA severity and 30-day mortality (OR = 3.32; P = 0.001). Conclusion Toxin detection by EIA/CCA associated with IDSA severity, but this study was unable to confirm an association with subsequent adverse outcomes. The molecular epidemiology of C. difficile has shifted, and this may have implications for the optimal diagnostic strategy for CDI. Disclosures All authors: No reported disclosures.

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