scholarly journals 62. Secondary Prophylaxis in Clostridioides difficile Infections: a Closer Look at Outcomes

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S149-S150
Author(s):  
Rubi Rodriguez ◽  
Surafel Mulugeta ◽  
Darius Faison ◽  
Rachel Kenney ◽  
Susan L Davis ◽  
...  
Keyword(s):  
Best Practice ◽  
Patient Characteristics ◽  
Secondary Prophylaxis ◽  
Convincing Evidence ◽  
Bivariate Analysis ◽  
Clostridioides Difficile ◽  
Clinical Culture ◽  
Dosing Regimens ◽  
History Of ◽  
The Impact

Abstract Background Clostridioides difficile infection (CDI) is an urgent public threat and carries a 25% chance of recurrence (rCDI). Data on safety and efficacy of oral vancomycin prophylaxis (OVP) in reducing rCDI is limited. We implemented a best practice advisory (BPA) to alert the prescriber and antibiotic stewardship (ASP) team for patients with CDI in the previous 60 days being initiated on systemic antimicrobials. The alert states “Don’t use antibiotics in patients with recent CDI without convincing evidence of need. Antibiotics pose a high risk of recurrence”. ASP team would recommended OVP if antibiotics are continued. This study evaluated the impact of the BPA alert on OVP prescribing and patient outcomes. Methods IRB approved, retrospective, observational cohort study comparing patients who received OVP to no OVP. Inclusion: adults with history of laboratory confirmed CDI, ≥ 14 days post-CDI treatment completion, BPA from 3/7/19 – 3/31/20, receiving non-CDI systemic antimicrobials, and without history of bezlotoxumab infusion. Data were reported using descriptive statistics and bivariate analysis. Primary endpoint: rCDI within 2-8 weeks post-OVP completion. Secondary endpoints: vancomycin-resistant Enterococcus spp (VRE) in clinical culture post-OVP and 1-year mortality. Results 70 patients included: 32 (46%) no-OVP and 38 (54%) OVP. Baseline characteristics, previous CDI treatment, and outcomes were similar (Table 1). Index CDI was severe in the OVP group (18, 47% vs. 9, 28%). Median Charlson comorbidity index: 7 (3 – 9) no-OVP and 7 (5 – 9) OVP. OVP regimens, 125 mg by mouth: once daily 4 (10%), twice daily 22 (58%), and every 6 hours 12 (32%). Median prophylaxis duration: 10 days (6 – 13). rCDI occurred in 3 (9%) no-OVP and 2 (5%) OVP (P = 0.654). Mortality: 10 (31%) no-OVP and 16 (42%) OVP (P = 0.458). Table 1. Patient Characteristics and Endpoints Conclusion OVP was utilized in approximately half of patients who required non-CDI antibiotics. Efficacy interpretation is limited by inconsistent dosing regimens and significant comorbid illness in the cohort. Future work will focus on further optimizing the BPA and standardizing the OVP regimen. Disclosures Rachel Kenney, PharmD, Medtronic, Inc. (Other Financial or Material Support, spouse is an employee and shareholder) Susan L. Davis, PharmD, Nothing to disclose

scholarly journals The Impermanence of Obsolescence: Performance Practice Challenges in Works Written for Revival Harpsichord

2021 ◽  
Author(s):  
◽  
Kristina Zuelicke
Keyword(s):  
Twentieth Century ◽  
Performance Practice ◽  
String Quartet ◽  
Best Practice ◽  
Limited Attention ◽  
Standard Type ◽  
Performance Interpretation ◽  
Current Availability ◽  
History Of ◽  
The Impact

<p>The revival harpsichord leads a double life today—enjoying a small fan base on the edge of obsolescence. Most regard the instrument as a twentieth-century foil to the more historically-oriented harpsichords that replaced them by around the mid-1970s. But they are also valued for the repertoire they inspired during the first seventy or so years of the twentieth century, along with their unique capabilities and signature sound. From mid-century onwards, when historical harpsichords began to gain a wider acceptance, revival harpsichords were derided as representing a false notion of teleological progress. Piano building technologies partially adapted to the construction of revival harpsichords have required compromises that ignore basic laws of the physics of sound—including the differences between plucking a string and striking it with hammer. The ontology of a harpsichord type that is piano-informed has led to a widespread conclusion that revival harpsichords are a mistaken concept and are unsuitable even for many of the compositions written for them. The common practice today is to adapt works written for revival harpsichord to historical harpsichords.  Limited attention has been given to revival harpsichords in recent academic literature. While mention is made of their historical significance, a current evaluation of the instruments and treatment of revival repertoire has been lacking. This dissertation seeks to critically assess instruments and repertoire by examining perspectives of authors, builders, performers, composers and critics, addressing current issues in performance practice such as the impact of changing instrumentation from revival to historical models. A case is made for valuing revival harpsichords on their own merits as well as applying first-hand knowledge of revival harpsichords to performances of revival repertoire on historical models. This methodology is supported by interviews conducted specifically for this dissertation, playing different revival models and in presenting information neither widely available nor understood, such as a picture of the current availability of revival instruments and details of their restoration.  This dissertation contributes to an understanding of revival harpsichords and their repertoire by, firstly, providing up-to-date information on the nature and history of the instrument, as well as highlighting the existence of many revival models, rather than accepting the notion of one standard type. Secondly, revival harpsichord reception is examined within a context of the changing purposes of harpsichord construction after 1889. Lastly, a selection of relevant repertoire is investigated, including Erik Bergman’s 1970 Energien for solo harpsichord (a critical edition of which also forms part of the Appendices), Darius Milhaud’s 1945 Sonata for Clavecin (or Piano) and Violin, op. 257, and Peter Child’s Concerto for Harpsichord and String Quartet (2005), which was written for an Eric Herz revival harpsichord.  A tradition already exists of compromising over and discussing which historical harpsichords to use for early music repertoire that spans centuries and the building practices of different geographic regions. This dissertation explores the extent to which revival harpsichords are indeed easily replaced by historical models for revival repertoire, or whether it is sometimes best practice to consider performing these works on the instruments for which they were originally conceived. Alternatively, the performer of a revival work may choose to take certain features of revival instruments into account in developing a performance interpretation on a historical model. Factors hindering performance on historical harpsichords can include performance practice challenges and controversies that arise when transferring pieces to these instruments. Some works defy straightforward alteration and require extensive editing, whereas others are more easily accommodated. Through an examination of repertoire in performance, interviews, and changes in the reception and use of revival harpsichords, this dissertation considers the position and relevance of revival harpsichords today.</p>

scholarly journals Venous thromboembolism and bleeding in a community setting

2009 ◽  
Vol 101 (05) ◽  
pp. 878-885 ◽  
Author(s):  
Joel Gore ◽  
George Reed ◽  
Darleen Lessard ◽  
Luigi Pacifico ◽  
Cathy Emery ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Total Mortality ◽  
Community Setting ◽  
Patient Characteristics ◽  
Recurrence Rates ◽  
Increased Risk ◽  
History Of ◽  
Recurrent Vte ◽  
The Impact

SummaryBleeding is the most frequent complication of antithrombotic therapy for venous thromboembolism (VTE). However, little attention has been paid to the impact of bleeding after VTE in the community setting. The purpose of this investigation was to describe the incidence rate of bleeding after VTE, to characterize patients most at risk for bleeding, and to assess the impact of bleeding on rates of recurrent VTE and all-cause mortality. The medical records of residents of the Worcester (MA, USA) metropolitan area diagnosed with ICD-9 codes consistent with potential VTE during 1999, 2001, and 2003 were individually validated and reviewed by trained data abstracters. Clinical characteristics, acute treatment, and outcomes (including VTE recurrence rates, bleeding rates, and mortality) over follow-up (up to 3 years maximum) were evaluated. Bleeding occurred in 228 (12%) of 1,897 patients with VTE during our follow-up. Of these, 115 (58.8%) had evidence of early bleeding occurring within 30 days of VTE diagnosis. Patient characteristics associated with bleeding included impaired renal function and recent trauma. Other than a history of prior VTE, the occurrence of bleeding was the strongest predictor of recurrent VTE (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.54–3.09) and was also a predictor of total mortality (HR 1.97; 95%CI 1.57–2.47). The occur-rence of bleeding following VTE is associated with an increased risk of recurrent VTE and mortality. Future study of antithrombotic strategies for VTE should be informed by this finding. Advances that result in decreased bleeding rates may paradoxically decrease the risk of VTE recurrence.

Abstract P232: Influence of Individualized Risk Prediction and Patient Preferences on Selection of Prasugrel Versus Clopidogrel at the Time of Percutaneous Coronary Intervention for an Acute Coronary Syndrome

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Adam C Salisbury ◽  
Kaijun Wang ◽  
David J Cohen ◽  
Yan Li ◽  
John A Spertus
Keyword(s):  
Decision Making ◽  
Acute Coronary Syndrome ◽  
Bleeding Risk ◽  
Patient Characteristics ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
Coronary Syndrome ◽  
Alternative Outcome ◽  
History Of ◽  
The Impact

Introduction: Given the need to weigh prevention of ischemia against bleeding risk with prasugrel vs. clopidogrel at the time of PCI for an acute coronary syndrome (ACS), we developed risk models for both outcomes from TRITON-TIMI 38. We then applied these models to each TRITON patient and examined how preferences for outcomes could influence thienopyridine selection. Methods: We built separate multivariable regression models for ischemia (cardiac death, MI, stroke) and bleeding (TIMI major/minor) from 12,579 patients in TRITON-TIMI 38 with no history of stroke or TIA. For each patient, we calculated the probability of ischemic and bleeding events with prasugrel vs. clopidogrel and the associated benefit:risk ratio (predicted difference in ischemic events/predicted difference in bleeding). We then examined the impact of alternative outcome weights - benefit:risk preference thresholds - on individualized decision making. Results: Based on individualized risk predictions, the majority of ACS patients treated with PCI (66%) may choose prasugrel when preventing ischemia is considered equally important as avoiding bleeding (Figure), but this proportion varied from 32% to 80% when the benefit:risk preference threshold was varied from 3 (reflecting a 3-times greater preference for avoiding bleeding) to 0.25 (reflecting a 4-times greater preference for avoiding ischemia). Conclusions: Based on empirical analyses, the expected absolute benefits and risks of prasugrel vs. clopidogrel depend highly on patient characteristics and preferences. Presenting individualized predictions of benefits and risks with competing treatments may improve shared decision making.

Distress screening for patients with a history of cancer during the COVID-19 pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13537-e13537
Author(s):  
Brooke Worster ◽  
Lauren Waldman ◽  
Gregory D. Garber ◽  
Subecha Dahal ◽  
Adam F Binder ◽  
...  
Keyword(s):  
Best Practice ◽  
Cancer Center ◽  
Cutoff Score ◽  
Distress Screening ◽  
Time Period ◽  
History Of ◽  
Diagnosis Of Cancer ◽  
New Diagnosis ◽  
Future Work ◽  
The Impact

e13537 Background: Although a diagnosis of cancer is widely accepted as resulting in significant levels of distress, distress itself cannot be considered benign and screening for distress is considered a best practice metric for patients receiving oncological care. Endorsed by NCCN, the Distress Thermometer (DT) considers a cutoff score of 4 or greater to identify patient with clinically relevant levels of distress. We hypothesized that the COVID-19 pandemic would manifest with higher levels of stress and anxiety in most persons by compounding the distress experienced by patients with a diagnosis of cancer. Methods: Patients with a new diagnosis of cancer underwent distress screening with the DT prior to a clinical appointment at a NCI-designated academic cancer center. Patients who scored 4 or higher were discussed at an Interprofessional Supportive Medicine patient conference or referred to oncology social work for appropriate evaluation and therapeutic care. By mid-March 2020, the SKCC catchment area was under a public health emergency with limited access to non-essential healthcare; therefore, we present data from 1/1-3/15/20 (pre-pandemic), 3/16-6/7/20 (pandemic peak with 2000+ daily cases in late April and peak daily deaths 300+ in May), and 6/8-8/30/20 (daily cases generally less than 700 except for occasional levels of 1000-in July and daily deaths less than 40 daily). Results: In the pre-pandemic time period, 60% of patients assessed reported a score of 4 or higher. During the subsequent periods—the first pandemic peak and the first post-pandemic period—the incidence of an elevated distress screen (4 or higher) was relatively stable at about 30%. Conclusions: Contrary to expectations, the DT screen identified less patient distress during the pandemic compared to pre-pandemic. Our results may be due to multiple factors—changes in processes and procedures to prioritize DT screening as pandemic risk became more apparent; an increased use of telemedicine; and the compounding of new, non-cancer related stressors resulting in the greater resiliency noted in disaster psychology. For example, during the first pandemic peak when the majority of patients were seen via telemedicine, the opportunity afforded by telemedicine for safety and decreased risk for COVID-19 infection may have reduced the overall distress experience. In addition, the compounding of stressors—the diagnosis of cancer, the risk of the pandemic, and its economic and financial stressors—may have influenced distress perception. Future work incorporating multiple distress assessment points may help better understand the impact of the layers of stress experienced by persons with cancer.[Table: see text]

A randomized trial of telephone versus in-person disclosure of BRCA 1/2 results.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1538-1538
Author(s):  
Angela R. Bradbury ◽  
Linda J. Patrick-Miller ◽  
Brian Egleston ◽  
Kyle Smith ◽  
Dominique Fetzer ◽  
...  
Keyword(s):  
State Anxiety ◽  
Psychological Factors ◽  
Patient Characteristics ◽  
Limited Data ◽  
General Anxiety ◽  
Genetic Test Results ◽  
The Family ◽  
Brca 1 ◽  
History Of ◽  
The Impact

1538 Background: While some providers use telephone to share genetic test results, there is limited data on the efficacy and impact on patient cognitive and emotional responses. Methods: Patients who completed in-person genetic counseling for BRCA 1/2 testing were randomized to telephone (TD) or in-person (IPD) disclosure. Baseline (BL) and post-disclosure (PD) surveys assessed knowledge, satisfaction and psychological factors. We used T-tests and multiple linear regressions. Results: 179 patients (68% of approached),126 (72%) agreed to be randomized; 36 (28%) declined randomization (Self-select IPD). Patient characteristics did not differ between arms. Change in knowledge, satisfaction and psychological factors did not differ between TD and IPD (Table). Self-select IPD participants had greater declines in depression and state anxiety (Table). In multivariable models, history of cancer was associated with greater declines in general anxiety (coef -1.4, p=0.01). BRCA+ results were associated with greater increases in knowledge (coef 3.2, p 0.02) and state anxiety (coef 12.0, p<0.01), and declines in satisfaction (coef -6.6, p<0.01). Having a mutation in the family was associated with greater declines in intrusive thoughts (coef -4.8, p<0.01). Conclusions: In general,telephone disclosure of BRCA1/2 results does not appear to negativelyimpact psychological outcomes but outcomes among carriers (BRCA+) differ. Larger studies are needed to understand the impact among subgroups and more diverse populations. Some patients preferred in-person communication and had different outcomes, suggesting more data is needed before telephone disclose is universally adopted. [Table: see text]

The Impact of Early Recognition and Treatment of Systemic Hypertension on Reducing Blood Pressure: The Hypertension and Vascular Evaluation Program

2020 ◽  
Vol 59 (11) ◽  
pp. 970-977
Author(s):  
Jungwon Min ◽  
Heather M. Griffis ◽  
Melodee Mendoza ◽  
Vicky Tam ◽  
Michelle Kaplinski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Condition ◽  
Early Recognition ◽  
Patient Characteristics ◽  
Mixed Effects ◽  
Systemic Hypertension ◽  
History Of ◽  
Family History Of Hypertension ◽  
The Impact

This study aimed to evaluate the effect of an outpatient systemic hypertension program and associated factors with attending recommended follow-up visit. All visits were tracked in the program, 2011 to 2018. We examined patient characteristics by follow-up status and changes in systolic blood pressure (SBP) and the risk of hypertension in follow-up patients using a mixed-effects regression model. Among 310 patients with first visits, 113 patients returned for a follow-up visit. Patients who did not attend a follow-up were older and less likely to have a severe chronic condition or a family history of hypertension than followed-up patients. The risk of hypertension was significantly reduced by the number of follow-up visits (odds ratio = 0.53, 95% confidence interval = 0.31-0.92). Adolescent SBP and body mass index percentiles decreased with more follow-up visits. As the risk of hypertension is significantly reduced with follow-up visits, additional effort should be made to improve the likelihood of follow-up attendance.

scholarly journals The Impermanence of Obsolescence: Performance Practice Challenges in Works Written for Revival Harpsichord

2021 ◽  
Author(s):  
◽  
Kristina Zuelicke
Keyword(s):  
Twentieth Century ◽  
Performance Practice ◽  
String Quartet ◽  
Best Practice ◽  
Limited Attention ◽  
Standard Type ◽  
Performance Interpretation ◽  
Current Availability ◽  
History Of ◽  
The Impact

<p>The revival harpsichord leads a double life today—enjoying a small fan base on the edge of obsolescence. Most regard the instrument as a twentieth-century foil to the more historically-oriented harpsichords that replaced them by around the mid-1970s. But they are also valued for the repertoire they inspired during the first seventy or so years of the twentieth century, along with their unique capabilities and signature sound. From mid-century onwards, when historical harpsichords began to gain a wider acceptance, revival harpsichords were derided as representing a false notion of teleological progress. Piano building technologies partially adapted to the construction of revival harpsichords have required compromises that ignore basic laws of the physics of sound—including the differences between plucking a string and striking it with hammer. The ontology of a harpsichord type that is piano-informed has led to a widespread conclusion that revival harpsichords are a mistaken concept and are unsuitable even for many of the compositions written for them. The common practice today is to adapt works written for revival harpsichord to historical harpsichords.  Limited attention has been given to revival harpsichords in recent academic literature. While mention is made of their historical significance, a current evaluation of the instruments and treatment of revival repertoire has been lacking. This dissertation seeks to critically assess instruments and repertoire by examining perspectives of authors, builders, performers, composers and critics, addressing current issues in performance practice such as the impact of changing instrumentation from revival to historical models. A case is made for valuing revival harpsichords on their own merits as well as applying first-hand knowledge of revival harpsichords to performances of revival repertoire on historical models. This methodology is supported by interviews conducted specifically for this dissertation, playing different revival models and in presenting information neither widely available nor understood, such as a picture of the current availability of revival instruments and details of their restoration.  This dissertation contributes to an understanding of revival harpsichords and their repertoire by, firstly, providing up-to-date information on the nature and history of the instrument, as well as highlighting the existence of many revival models, rather than accepting the notion of one standard type. Secondly, revival harpsichord reception is examined within a context of the changing purposes of harpsichord construction after 1889. Lastly, a selection of relevant repertoire is investigated, including Erik Bergman’s 1970 Energien for solo harpsichord (a critical edition of which also forms part of the Appendices), Darius Milhaud’s 1945 Sonata for Clavecin (or Piano) and Violin, op. 257, and Peter Child’s Concerto for Harpsichord and String Quartet (2005), which was written for an Eric Herz revival harpsichord.  A tradition already exists of compromising over and discussing which historical harpsichords to use for early music repertoire that spans centuries and the building practices of different geographic regions. This dissertation explores the extent to which revival harpsichords are indeed easily replaced by historical models for revival repertoire, or whether it is sometimes best practice to consider performing these works on the instruments for which they were originally conceived. Alternatively, the performer of a revival work may choose to take certain features of revival instruments into account in developing a performance interpretation on a historical model. Factors hindering performance on historical harpsichords can include performance practice challenges and controversies that arise when transferring pieces to these instruments. Some works defy straightforward alteration and require extensive editing, whereas others are more easily accommodated. Through an examination of repertoire in performance, interviews, and changes in the reception and use of revival harpsichords, this dissertation considers the position and relevance of revival harpsichords today.</p>

scholarly journals The Impact of Emergency Interventions and Patient Characteristics on the Risk of Heart Failure in Patients with Nontraumatic OHCA

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Cheng Hsu Chen ◽  
Chih-Yu Chang ◽  
Mei-Chueh Yang ◽  
Jr-Hau Wu ◽  
Ching-Hui Liao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Comparison Group ◽  
Patient Characteristics ◽  
Emergency Interventions ◽  
History Of ◽  
The Impact ◽  
New Onset

Background. Since out-of-hospital cardiac arrest- (OHCA-) related dysfunction (ischemic/reperfusion injury and inflammatory response) might result in long-term impairment, we suspect that new-onset heart failure might be common in long-term survivors. However, these relationships had not been well addressed, and we aimed to analyze the impact of emergency interventions and patient characteristics on the risk of new-onset heart failure in patients with nontraumatic OHCA. Methods. The Taiwanese government healthcare database contains data for 49,101 nontraumatic OHCA adult patients from 2011-2012, which were analyzed in this study. Nontraumatic OHCA patients who survived to the intensive care unit (ICU) were included as the study group (n = 7,321). Matched patients (n = 21,963) were recruited as a comparison group. Patients with any history of heart failure or cardiac arrest were not included in either group. All patients were followed-up for 6 months for the identification of new-onset heart failure. Adjustments were made for demographics, age, emergency interventions, and comorbidities as potential risk factors. Results. In all, 3.84% (n = 281) of OHCA patients suffered new-onset heart failure, while only 1.24% (n = 272) of matched patients in the comparison group suffered new-onset heart failure. Strong risk factors for heart failure were age (60–75 years, HR: 11.4; 95% CI: 9–14.4), medical history (myocardial infarction, HR: 2.47; 95% CI: 2.05–2.98 and cardiomyopathy, HR: 2.94; 95% CI: 1.45–5.94), and comorbidities during hospitalization (ischemic heart disease, HR: 4.5; 95% CI: 3.46–5.86). Only extracorporeal membrane oxygenation (ECMO) decreased the risk of heart failure. Most (53.6%) heart failure events occurred within 60 days after OHCA. Conclusion. An age from 61 to 75 years, a history of myocardial infarction or cardiomyopathy, and ischemic heart disease or infection as comorbidities occurring during hospitalization were strong risk factors for new-onset heart failure in OHCA patients. However, ECMO could decrease this risk. More importantly, most heart failure events occurred within 60 days after OHCA.

scholarly journals 1048Characteristics of ST-Elevation Myocardial Infarction (STEMI) patients in Asia Pacific: findings from the ASPECT collaboration

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
HuiJun Chih ◽  
Angela Brennan ◽  
KK Yeo ◽  
Mark Chan ◽  
Bryan Yan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hong Kong ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Patient Characteristics ◽  
Stemi Patient ◽  
Asia Pacific ◽  
Chi Squared ◽  
History Of ◽  
The Impact

Abstract Background The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration was established to better understand the characteristics of patients undergoing PCI and cardiac interventions across the Asia Pacific region, including STEMI. The aim of this study was to compare STEMI patient characteristics across Asia Pacific (AP) countries in order to understand regional differences. Methods Each site across Australia, Singapore, Malaysia, Vietnam and Hong Kong provided de-identified individual patient data. Comparison of characteristics by sites were performed using one-way ANOVA, Kruskal-Wallis or Chi-squared tests, using Stata 14.2. Results Of the 12,620 cases, there were more males (p &lt; 0.001) and the average of patients’ age ranged from 55 (Malaysia) to 68 (Vietnam) years old. Family history of coronary artery disease was not common amongst Hong Kong (1%) and Singaporean (12%) patients, and most patients did not have history of congestive heart failure, peripheral vascular disease or coronary artery bypass grafting. History of dyslipidaemia varied significantly among patients in Malaysia (98%) and Vietnam (12%) (p &lt; 0.001). About 37% of the Malaysian patients had previous myocardial infarction, which is greater than twice of other cohorts (p &lt; 0.001). Most cohort had either normal or mild ejection fraction (EF) but 40% of the Singaporean patients had severely reduced EF (p &lt; 0.001). Conclusions Patient characteristics varied significantly across AP countries. On-going analyses will focus on the impact of varying patient characteristics on clinical outcomes. Key messages As characteristics varied, prevention and procedural strategies need to be adapted carefully. Additional input from other AP countries will better inform these strategies.

scholarly journals 2421. Efficacy of Secondary Prophylaxis with Oral Vancomycin in Preventing Recurrent Clostridioides difficile Infections in Patients Receiving Systemic Antibiotics

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S836-S836
Author(s):  
Kelly E Pillinger ◽  
Jason K Lew ◽  
Kelly M Conn ◽  
Stephanie Shulder
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Secondary Prophylaxis ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Significant Difference ◽  
Systemic Antibiotics ◽  
The Impact

Abstract Background One of the major challenges in Clostridioides difficile infection (CDI) is preventing recurrence, particularly in the setting of risk factors, such as systemic antibiotics that impact the gut microbiome. There are little data to demonstrate the impact of secondary prophylaxis with oral vancomycin and due to the lack of evidence, the IDSA guidelines do not make a recommendation. Methods This was a multi-site, retrospective cohort study of adult inpatients within the University of Rochester Medical Center who received either a high- or medium-risk systemic antibiotic between July 1, 2013 and September 30, 2018 and had a positive C. difficile test within one year prior to admission. The primary endpoint was incidence of recurrent CDI within 90 days from the start of antibiotics in patients who received oral vancomycin prophylaxis (OVP) vs. those who did not receive prophylaxis (control). Results Of 425 patients screened, 153 patients were included in the control and 78 patients in the OVP group. The OVP group was more likely to be immunosuppressed (P < 0.001), have increased hospital length of stay (P < 0.001), receive a proton pump inhibitor (P = 0.049), have a prior episode of CDI within the previous 90 days (P < 0.001), and have > 1 prior episode of CDI (P = 0.038). The control group was more likely to have received metronidazole for the most recent CDI episode (P < 0.001), likely reflecting mild-moderate severity. Recurrent CDI within 90 days was 10.3% in the OVP group compared with 17.6% in the control (P = 0.175). A subgroup analysis of the patients with recurrent CDI found the time to recurrence from initiation of systemic antibiotics was similar in the OVP group compared with control (43 vs 30 days, P = 0.223). Conclusion While there was not a statistically significant difference in recurrent CDI within 90 days, the OVP group had numerous risk factors that made these patients at higher risk for recurrence compared with the control group. This may be clinically important and certain risk factors, such as timing of previous CDI episode, could be used to guide which patients should receive OVP. Prospective studies are needed to better elucidate the role of OVP and better define the patients that may benefit the most. Disclosures All authors: No reported disclosures.

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