scholarly journals 784. A Novel Method to Assess Virulence of Clostridioides difficile: Focus on C. difficile Ribotype 106

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S436-S437
Author(s):  
Masaad Almutairi ◽  
Kevin W Garey ◽  
Faris S Alnezary ◽  
Saad Fallatah ◽  
Anne J Gonzales-Luna ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disease Severity ◽  
Clinical Cure ◽  
Analysis Method ◽  
Research Support ◽  
Recurrence Rates ◽  
Clostridioides Difficile ◽  
The Usa ◽  
Novel Method ◽  
Cure Rates

Abstract Background Clostridioides difficile ribotype (RT) 106 has emerged as one of the most commonly isolated strains in the USA and worldwide. However, studies investigating clinical outcomes associated with this strain are lacking. The purpose of this study was to compare disease severity, clinical cure, and recurrence rates associated with CDI caused by RT106 vs two other comparator strains. Methods This multicenter study (20 hospitals) assessed hospitalized patients infected with C. difficile RT106 compared to patients infected with a known hypervirulent strain (RT027) and a strain associated with less virulence (RT014-020). Electronic medical records were reviewed by investigators blinded to RT. Disease severity was calculated using the 2017 IDSA/SHEA guidelines, initial clinical cure was defined as resolution of symptoms by day 6 of treatment, and recurrence assessed 90-days after the initial positive toxin test. All isolates were ribotyped using PCR fluorescent ribotyping. Results A total of 380 patients with CDI aged 66 ± 17 years (Female: 59.5%; White: 70.5%) infected with RT 106 (115/380; 30.3%), RT027 (116/380; 30.5%), and RT014-020 (149/380; 39.2%) were included. Approximately half of the patients had severe CDI (47.6%). Disease severity was highest for RT027 (59.3%) followed by RT014-020 (45%), and RT106 (41.2%). Clinical cure rates were lowest for RT027 (74.8%) followed by RT106 (77.8%), and RT014-020 (85.5%). 90-day recurrence rates were highest for RT027 (20.7%) followed by RT106 (13.3%), and RT014-020 (8.7%). Compared to RT014-020, virulence increased with RT106 (OR:1.10; 95% CI: 0.67-1.8) and RT027 (OR: 2.0: 95% CI: 1.2-3.5) was noted. Conclusion Our novel analysis method established RT106 as a moderately virulent C. difficile strain vs. comparator ribotypes. This study presents a novel method for comparing clinical outcomes for emerging ribotypes. Disclosures Kevin W. Garey, PharmD, MS, FASHP, Merck & Co. (Grant/Research Support, Scientific Research Study Investigator)

scholarly journals 762. Real-World Utilization of C. difficile Drug Treatments and Associated Clinical Outcomes in a US Hospital System

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S478-S479
Author(s):  
Lauren McDaniel ◽  
Nathan Everson ◽  
Melissa White ◽  
Engels N Obi ◽  
Yiyun Chen ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Cure ◽  
Treatment Options ◽  
Sustained Response ◽  
Oral Vancomycin ◽  
Research Support ◽  
Recurrence Rates ◽  
Hospital System ◽  
Drug Treatments ◽  
Order Set

Abstract Background IDSA recommends use of fidaxomicin or oral vancomycin for treatment of initial episode or first recurrence of Clostridioides difficile infection (CDI). This study aimed to evaluate impact of a clinical decision support order set driving appropriate use of fidaxomicin on utilization of CDI drug treatments and associated clinical outcomes. Methods This was a retrospective, quasi-experimental study evaluating CDI therapies pre- (8/2016-11/2017) and post- (5/2018-1/2020) CDI order set implementation at a level-one trauma center located in Virginia. Admitted adult patients were included if CDI testing was positive for a 1st or 2nd episode and received active CDI treatment. Exclusions included fulminant CDI and CDI diagnosis by PCR with < 3 bowel movements or laxative use within 24 hours. The primary outcome was CDI recurrence within 30 days of completing therapy in patients who achieved clinical cure. Secondary outcomes were evaluated at 30 and 90 days and included sustained response and CDI-related readmissions. Results After screening, 186 patients in the pre-group and 187 in the post-group were included. Median age was 68 [59-77], most patients had an initial CDI episode (88.2%) and were diagnosed with severe CDI (50.7%). Baseline characteristics were similar between each group on Charlson comorbidity index, ICU admission, CDI risk factors, and concomitant antibiotic use. Primary treatment options in the pre-group were most commonly metronidazole 47.9% and oral vancomycin 50.5%, and in the post-group were fidaxomicin 56.7% and oral vancomycin 41.7% (Figure 1). CDI recurrence rates at 30 days post-index medication (17.2% vs. 6.3%, p=0.004) were lower in the post-group (Table 1). Clinical cure (84.4% vs. 94.1%, p=0.002) and sustained response at 90 days (55.9% vs. 73.3%, p< 0.001) were higher in the post-group. CDI recurrence rates at 90 days and CDI-related readmissions at 30 and 90 days were also lower in the post group. Figure 1. CDI Treatment Utilization Table 1. Clinical Outcomes Conclusion Implementation of the CDI order set increased fidaxomicin use and was associated with a decrease in CDI recurrences and CDI-related readmissions and increase in clinical cure and sustained response. Findings suggest increased first-line use of fidaxomicin results in better clinical outcomes. Disclosures Lauren McDaniel, Pharm.D., BCIDP, Merck Sharp & Dohme Corp (Grant/Research Support) Nathan Everson, Pharm.D., BCIDP, AAHIVE, Merck & Co. (Grant/Research Support) Melissa White, PharmD, Merck Sharpe & Co (Grant/Research Support) Engels N. Obi, PhD, Merck & Co. (Employee, Shareholder) Yiyun Chen, PhD, Merck & Co., Inc (Employee) Rose Kohinke, PharmD, Merck Sharpe & Co (Research Grant or Support)

Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis

2020 ◽  
Vol 68 (4) ◽  
pp. 888-892 ◽  
Author(s):  
Paige A Bishop ◽  
Carmen Isache ◽  
Yvette S McCarter ◽  
Carmen Smotherman ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Clinical Success ◽  
Audit And Feedback ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Usa ◽  
The Impact

Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

scholarly journals 1438. Escherichia coli (EC) ST131-H30 Clonal Group is Associated with Antimicrobial Resistance, Illness Severity, Host Compromise, and Non-Cure among Patients with Bacteriuria

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S525-S525
Author(s):  
Melanie T Mahoney ◽  
Hunter V Brigman ◽  
Brian Johnston ◽  
Brian R Raux ◽  
James R Johnson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Clinical Cure ◽  
Academic Medical Center ◽  
Illness Severity ◽  
Advisory Board ◽  
Apache Ii ◽  
Esbl Production ◽  
Empiric Treatment ◽  
Cure Rates

Abstract Background EC sequence type ST131 is the leading cause of extraintestinal EC infections, and accounts for most fluoroquinolone (FQ)-resistant and extended-spectrum β-lactamase (ESBL)-producing EC clinical isolates. The ST131-H30 subclone (H30) is responsible for most antimicrobial resistance within ST131; however, H30’s impact on clinical outcomes is poorly defined. We compared empiric treatment patterns and clinical outcomes of patients with bacteriuria caused by ST131 vs. non-ST131 EC, and by H30 vs. non-H30 EC strains. Methods Phylogroups, ST131, H30, and CTX-M-type β-lactamase genes were detected by PCR for 142 non-duplicate EC isolates collected prospectively from hospitalized or emergency-department-attending adults with monomicrobial bacteriuria at a Boston academic medical center (August 2013–January 2014). Clinical and microbiologic data were collected retrospectively from electronic health records. Baseline characteristics, empiric treatment, and clinical cure rates were compared between ST131 vs. non-ST131, and H30 vs. non-H30, patient cohorts. Results Of 142 patients with EC bacteriuria, most (76%) were female and elderly (mean age 65.2 ± 21.2 years). Overall, 35% of isolates were ST131, of which 80% (39/49) were H30. Compared with other isolates, H30 isolates demonstrated a higher frequency of ESBL production (33% vs. 8%; P < 0.001) and FQ resistance (90% vs. 8%; P > 0.001). Patients with H30 isolates (vs. non-H30 isolates) were older (mean 73.4 ± 13.6 vs. 62.1 ± 22.7 years; P < 0.01), had higher median (interquartile range [IQR]) APACHE II scores (10 [4] vs. 8 [9.5]; P = 0.01), more commonly had underlying complicating conditions (100% vs. 83%; P = 0.03) and received in vitro-inactive empirical treatment (26% vs. 3%; P < 0.01), and had a numerically lower clinical cure rate (84% vs. 96%; P = 0.08). In contrast, patients with ST131 vs. non-ST131 isolates had similar median [IQR] APACHE II scores (9 [5] vs. 8 [9]), frequencies of symptomatic UTI (61% vs. 70%) and underlying complicating conditions (24% vs. 19%), and clinical cure rates (87% vs. 95%). Conclusion Among patients with EC bacteriuria, the ST131-H30 subclone was associated significantly with ESBL production, FQ resistance, illness severity, host compromise, and numerically lower clinical cure rates in symptomatic UTI. Disclosures Elizabeth B. Hirsch, PharmD, Merck: Grant/Research Support, Research Grant; Nabriva Therapeutics: Advisory Board; Paratek Pharmaceuticals: Advisory Board.

scholarly journals 2670. Clostridioides difficile Infection (CDI) in Solid-Organ (SOT) and Hematopoietic Stem Cell Transplant (HCT) Recipients: A Prospective Multinational Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S936-S936
Author(s):  
Emily Blumberg ◽  
Collins Gary ◽  
Jo-Anne H Young ◽  
Minh-Hong Nguyen ◽  
David Michonneau ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Negative Impact ◽  
Severe Disease ◽  
Baseline Risk ◽  
First Episode ◽  
Solid Organ ◽  
Cell Transplant ◽  
Recurrence Rates ◽  
Hematopoietic Stem ◽  
Clostridioides Difficile

Abstract Background CDI is an important cause of morbidity and mortality in SOT and HCT patients (pts). In retrospective single-center analyses, severe disease and relapse were common. We undertook a multicenter prospective observational study to evaluate outcomes of CDI among both SOT and HCT patients. Methods Adults with a first episode of CDI, defined as 3 liquid stools/24 h with the detection of C. difficile toxin in stool, within the first 2 years of SOT or HCT were recruited from 12 centers internationally in the INSIGHT network. At enrollment, demographics, comorbidities, medication histories and outcomes were collected prospectively over 90 days to assess clinical cure, recurrences and complications and to define baseline risk factors for clinical cure and recurrent CDI. Results 132 patients (81 SOT, 51 HCT (32 allogeneic)) were enrolled: median age 56 years, 62.1% were males, 97% were hospitalized. 80.3% were diagnosed by DNA assay. CDI occurred a median of 20 days post transplant (IQR: 6–133). 108 patients were on PPIs. 98.5% were on antibiotics before CDI. 1st line treatment regimen was oral vancomycin in 66 patients (40 SOT, 26 HCT), metronidazole in 48 patients (27 SOT, 21 HCT), both drugs in 14 (10 SOT, 4 HCT), fidaxomicin (3) and linezolid (1). Rejection within 60 days before CDI was uncommon (6.2% SOT) as was GVHD (27.5%). 110 patients (83%, 95% CI: 46–89)) (65 SOT, 45 HCT) had clinical cure; 18% (95% CI: 11–27) had recurrent CDI, 2 were admitted to the ICU due to CDI, 11 (8.3%) died (2 HCT related to CDI). Among baselines variables, only first-line regimen was associated with a higher rate of clinical cure (P = 0.003), most notably for SOT. Factors that did not have a statistically significant negative impact on clinical cure included sex, age > 60, race, country, transplant type, steroids, diabetes, CMV viremia/disease, WBC > 15,000, creatinine > 1.5 mg/dL, or specific antibiotic given prior to CDI. Higher recurrence rates were associated with metronidazole-only regimen (OR: 4.6, 95% CI: 1.6–12.8; P = 0.004) and a history of CMV after transplant (OR: 5.2, 95% CI: 1.7–15.7; P = 0.003). Conclusion Despite their immunosuppressed state, recurrence, ICU admission and mortality occurred in a minority of SOT and HCT with CDI. Initial use of metronidazole and CMV viremia/disease were associated with higher recurrence rates. Disclosures All authors: No reported disclosures.

scholarly journals 1367. Clinical Cure in Secondary Efficacy Populations in Patients With Complicated Urinary Tract Infection Treated With ZTI-01 (Fosfomycin for Injection): Findings From the ZEUS Trial

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S418-S419 ◽  
Author(s):  
Keith Kaye ◽  
Louis B Rice ◽  
Viktor Stus ◽  
Olexsiy Sagan ◽  
Elena Fedosiuk ◽  
...  
Keyword(s):  
United States ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Clinical Cure ◽  
Complicated Urinary Tract Infection ◽  
The United States ◽  
Research Support ◽  
Gram Negative ◽  
Cure Rates

Abstract Background ZTI-01 (fosfomycin for injection) is an investigational epoxide antibiotic with a differentiated mechanism of action (MOA) inhibiting an early step in bacterial cell wall synthesis. ZTI-01 has a broad spectrum of in vitro activity, including multidrug-resistant Gram-negative pathogens, and is being developed for the treatment of patients with complicated urinary tract infection (cUTI) and acute pyelonephritis (AP) in the United States. Methods ZEUS was a multicenter, double-blind, Phase 2/3 trial in hospitalized adults with cUTI and AP to evaluate safety and efficacy. Randomized patients received 6 g ZTI-01 q8h or 4.5 g IV piperacillin/tazobactam (PIP-TAZ) q8h for 7 days; patients with baseline bacteremia could receive up to 14 days; study continued to late follow-up (LFU, 26 ± 2 days). Oral step-down therapy was prohibited. ZTI-01 met the primary endpoint of noninferiority to PIP-TAZ. Secondary objectives included comparing clinical cure rates (assessed by investigator) in the modified intent-to-treat (MITT), microbiologic MITT (m-MITT), clinical evaluable (CE), and microbiologic evaluable (ME) populations at test-of-cure (TOC, Day 19 ± 2 days). Results There were 464 patients randomized who received study drug. In all populations, clinical cure rates at TOC were high and similar between treatment groups (&gt;90%) (table). Conclusion These results demonstrate consistent efficacy in multiple secondary efficacy populations for patients with cUTI and AP who were treated with either ZTI-01 or PIP-TAZ. If approved by FDA, ZTI-01 may provide a new IV option with a differentiated MOA for patients in the United States with serious Gram-negative infections. 95% confidence intervals (CIs, two-sided) were computed using a continuity-corrected Zstatistic. Disclosures K. Kaye, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee. L. B. Rice, Zavante Therapeutics, Inc.: Scientific Advisor, Consulting fee. V. Stus, Zavante Therapeutics, Inc.: Investigator, Research support. O. Sagan, Zavante Therapeutics, Inc.: Investigator, Research support. E. Fedosiuk, Zavante Therapeutics, Inc.: Investigator, Research support. A. Das, Zavante Therapeutics, Inc.: Consultant, Consulting fee. D. Skarinksy, Zavante Therapeutics, Inc.: Employee and Shareholder, Salary. P. B. Eckburg, Zavante Therapeutics, Inc.: Consultant and Shareholder, Consulting fee. K. Manvelian, Zavante Therapeutics, Inc.: Employee and Shareholder, Salary. E. J. Ellis-Grosse, Zavante Therapeutics, Inc.: Employee and Shareholder, Salary.

Surotomycin (A Novel Cyclic Lipopeptide) vs. Vancomycin for the Treatment of Clostridioides difficile Infection: A Systematic Review and Meta-analysis

2019 ◽  
Vol 14 (3) ◽  
pp. 166-174 ◽  
Author(s):  
Aziz Muhammad ◽  
Desai Madhav ◽  
Fatima Rawish ◽  
Thoguluva C. Viveksandeep ◽  
Eid Albert ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Meta Analysis ◽  
Promising Alternative ◽  
Cyclic Lipopeptide ◽  
Treatment And Prevention ◽  
Clostridioides Difficile ◽  
Specific Strain ◽  
Clostridioides Difficile Infection ◽  
Cure Rates

Background: Current guidelines recommend the use of vancomycin for the initial treatment of moderate to severe Clostridioides difficile Infection (CDI). Surotomycin, a novel antibiotic, has been utilized for the management of CDI with variable results. Methods: A systematic literature search was performed using the following electronic databases [Medline, Embase, google scholar and Cochrane] for eligible studies. Randomized controlled trials comparing Surotomycin with Vancomycin for the CDI treatment were included. Demographic variables and outcomes (CDI resolution, CDI recurrence, B1/NAP1/027-specific strain treatment, B1/NAP1/027-strain recurrence, death not related to treatment) were analyzed. The primary outcome was clinical cure rate defined as the resolution of CDI at the end of the 10-day drug course. Results: Three RCTs met the inclusion criteria with a total of 1280 patients with CDI who received either surotomycin 250 mg twice daily (642 patients) or vancomycin 125 mg four times daily (638 patients). Clinical cure rates after 10 days of treatment with either surotomycin or vancomycin were not significantly different (pooled OR: 0.89, 95% CI 0.66-1.18, p=0.41). Sustained clinical response at clinical follow-up and the overall recurrence of CDI were also not significantly different between the two groups – pooled OR 1.15 (95% CI 0.89-1.50, p=0.29) and pooled OR 0.74 (95%CI 0.52- 1.04, p=0.08), respectively. With regards to the NAP1/BI/027 strain, patients in the surotomycin group had significantly lower rates of recurrence compared to vancomycin (pooled OR 0.35, 95% CI 0.19-0.63, p<0.01). Conclusion: Surotomycin is non-inferior to vancomycin and offers a promising alternative for the treatment and prevention of C. diff infection.

scholarly journals A prospective, observational study of fidaxomicin use for Clostridioides difficile infection in France

2021 ◽  
Vol 49 (6) ◽  
pp. 030006052110212
Author(s):  
Benoit Guery ◽  
Pierre Berger ◽  
Remy Gauzit ◽  
Magali Gourdon ◽  
Frédéric Barbut ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Cure ◽  
Prospective Observational Study ◽  
Adverse Outcomes ◽  
High Rate ◽  
Clostridioides Difficile ◽  
Real World Setting ◽  
Hospitalised Patients ◽  
Clostridioides Difficile Infection ◽  
Cure Rates

Objective To describe the characteristics, management and outcomes of hospitalised patients with Clostridioides difficile infection (CDI) treated with and without fidaxomicin. Methods This prospective, multicentre, observational study (DAFNE) enrolled hospitalised patients with CDI, including 294 patients treated with fidaxomicin (outcomes recorded over a 3-month period) and 150 patients treated with other CDI therapies during three 1-month periods. The primary endpoint was baseline and CDI characteristics of fidaxomicin-treated patients. Results At baseline, the fidaxomicin-treated population included immunocompromised patients (39.1%) and patients with severe (59.2%) and recurrent (36.4%) CDI. Fidaxomicin was associated with a high rate of clinical cure (92.2%) and low CDI recurrence (16.3% within 3 months). Clinical cure rates were ≥90% in patients aged ≥65 years, those receiving concomitant antibiotics and those with prior or severe CDI. There were 121/296 (40.9%) patients with adverse events (AEs), 5.4% with fidaxomicin-related AEs and 1.0% with serious fidaxomicin-related AEs. No fidaxomicin-related deaths were reported. Conclusions Fidaxomicin is an effective and well-tolerated CDI treatment in a real-world setting in France, which included patients at high risk of adverse outcomes. Trial registration: Description of the use of fidaxomicin in hospitalised patients with documented Clostridium difficile infection and the management of these patients (DAFNE), NCT02214771, www.ClinicalTrials.gov.

Efficacy of Terbinafine for Toenail Onychomycosis

2001 ◽  
Vol 91 (3) ◽  
pp. 127-131 ◽  
Author(s):  
Richard Pollak ◽  
Stephan A. Billstein
Keyword(s):  
Clinical Cure ◽  
Large Scale ◽  
Multicenter Trial ◽  
Fungal Culture ◽  
Open Label ◽  
Recurrence Rates ◽  
Clinical Recurrence ◽  
Treatment Groups ◽  
Mycologic Cure ◽  
Cure Rates

The efficacy of terbinafine (250 mg/day) in the treatment of toenail onychomycosis was evaluated in a large open-label, multicenter trial of 12, 18, and 24 weeks of therapy. All 1,534 patients had onychomycosis, confirmed by either positive potassium hydroxide (KOH) wet mount, positive fungal culture, or both, and all received at least 12 weeks of treatment. Treatment was continued for an additional 6 or 12 weeks, depending on the extent of the disease at follow-up. Mycologic cure rates (negative culture plus negative KOH) at week 72 were 72.1% in the 12-week treatment group, 72.5% in the 18-week group, and 77.0% in the 24-week group. In all groups, clinical cure rates were higher at week 72 than at week 48: 49.5% of the 12-week group, 49.2% of the 18-week group, and 44.6% of the 24-week group experienced clinical cure by the end of the study. Both mycologic and clinical recurrence rates were low in all treatment groups at the 72-week assessment. The results of this study confirm the efficacy of terbinafine in the treatment of toenail onychomycosis as demonstrated in previous registration and large-scale clinical trials. (J Am Podiatr Med Assoc 91(3): 127-131, 2001)

Outcomes of Health Care–Associated Pneumonia Empirically Treated with Guideline-Concordant Regimens Versus Community-Acquired Pneumonia Guideline–Concordant Regimens for Patients Admitted to Acute Care Wards from Home

2013 ◽  
Vol 47 (1) ◽  
pp. 9-19 ◽  
Author(s):  
Jenny I Chen ◽  
Leonard N Slater ◽  
George Kurdgelashvili ◽  
Khawaja O Husain ◽  
Chris A Gentry
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Broad Spectrum ◽  
Clinical Cure ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Empiric Antibiotics ◽  
Cure Rates ◽  
Health Care Associated Pneumonia

BACKGROUND The introduction of the health care–associated pneumonia (HCAP) categorization expanded recommendations for broad-spectrum empiric antibiotics to pneumonia patients presenting from the community with recent health care–system exposure. However, the efficacy of such regimens in improving clinical outcomes in these patients has not been well established. OBJECTIVE To compare the clinical outcomes of HCAP patients treated initially with HCAP guideline–concordant antibiotic regimens to those treated initially with community-acquired pneumonia (CAP) guideline-concordant antibiotic regimens. METHODS This retrospective study included HCAP patients presenting from home and admitted to general medical wards. HCAP regimen patients were treated empirically with at least 1 antipseudomonal agent. All other patients were assigned to the CAP regimen group. The primary end point was clinical cure at 30 days postdischarge. Subgroup analysis was performed in patients hospitalized 1–30 days and 31–90 days before the HCAP admission. RESULTS Of 228 HCAP admissions, 122 patients received CAP regimens and 106 received HCAP regimens. The 2 groups were similar at baseline, including Pneumonia Severity Index scores. Attributable clinical cure occurred in 75.4% of CAP regimen patients and 69.8% of HCAP regimen patients (p = 0.34). Overall clinical cure occurred in 59.8% of CAP regimen patients and 54.7% of HCAP regimen patients (p = 0.44). The CAP regimen group used fewer days of intravenous antibiotics (4.39 vs 7.75, p < 0.0001) and had shorter lengths of stay (6.36 vs 8.58 days, p < 0.0001). For patients hospitalized 31–90 days earlier, clinical cure was higher in the CAP regimen group (attributable, 82.9% vs 60.0%, p = 0.0090; overall, 67.1% vs 47.5%, p = 0.044). CONCLUSIONS Compared to CAP guideline–concordant regimens, treatment of HCAP with HCAP guideline–concordant regimens did not increase clinical cure rates and was associated with lower clinical cure rates in patients hospitalized 31–90 days prior to the HCAP admission. This study suggests that broad-spectrum empiric antibiotics may not be necessary in all HCAP patient groups.

scholarly journals Fecal Microbiota Transplant in Severe and Non-Severe Clostridioides difficile Infection. Is There a Role of FMT in Primary Severe CDI?

2021 ◽  
Vol 10 (24) ◽  
pp. 5822
Author(s):  
Daniel Popa ◽  
Bogdan Neamtu ◽  
Manuela Mihalache ◽  
Adrian Boicean ◽  
Adela Banciu ◽  
...  
Keyword(s):  
Fecal Microbiota ◽  
Small Sample ◽  
Cure Rate ◽  
Recurrence Rates ◽  
Fecal Microbiota Transplant ◽  
Risk Of Recurrence ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Cure Rates

Background: Faecal microbiota transplant (FMT) is a highly effective therapy for recurrent Clostridioides difficile infection (rCDI) with cure rates ranging between 85 and 92%. The FMT role for primary Clostridioides difficile infection (CDI) has yet to be settled because of limited data and small-sample studies presented in the current literature. Our study goals were to report the risk factors and the risk of recurrence after FMT for each CDI episode (first, second, and third) and to explore if there is a role of FMT in primary severe CDI. Methods: We conducted a retrospective study to analyze the clinical characteristics and the outcomes of 96 FMT patients with a prior 10 day course of antibiotic treatment in the medical records, of which 71 patients with recurrent CDI and 25 patients with a primary CDI. Results: The overall primary cure rate in our study was 88.5% and the primary cure rate for the severe forms was 85.7%. The data analysis revealed 5.25%, 15.15%, and 27.3% FMT recurrence rates for primary, secondary, and tertiary severe CDI. The risk of recurrence was significantly associated with FMT after the second and the third CDI severe episodes (p < 0.05), but not with FMT after the first severe CDI episode. Conclusions: This study brings new data in supporting the FMT role in CDI treatment, including the primary severe CDI, however, further prospective and controlled studies on larger cohorts should be performed in this respect.

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