scholarly journals 1593. Recurrence of Clostridium difficile Infection in Multiple Myeloma Patients Receiving Prophylactic Oral Vancomycin or Oral Metronidazole vs. No Prophylaxis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S498-S499
Author(s):  
Gisele Moran ◽  
Naveen Yarlagadda ◽  
Sandra Susanibar ◽  
Atul Kothari ◽  
Juan Carlos Rico ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Oral Vancomycin ◽  
Oral Metronidazole

scholarly journals Impact of an automatic hospital probiotic protocol on Clostridioides (Clostridium) difficile infection (CDI) rates and CDI antibiotic usage in a community hospital setting

2019 ◽  
Vol 21 (2) ◽  
pp. 72-75
Author(s):  
Douglas Slain ◽  
Amy Georgulis ◽  
Ron Dermitt ◽  
Laura Morris ◽  
Stephen M Colodny
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Community Hospital ◽  
Hospital Setting ◽  
Saccharomyces Boulardii ◽  
Antibiotic Usage ◽  
Oral Vancomycin ◽  
Hospitalised Patients ◽  
Oral Metronidazole

The aim of the present study was to see how widespread preventative use of the probiotic Saccharomyces boulardii via automatic protocol in hospitalised patients receiving antibacterials affected rates of hospital-associated Clostridioides ( Clostridium) difficile infection (HA-CDI). Rates of HA-CDI appeared to be similar between the pre-protocol and protocol periods. Use of CDI treatment antibiotics (oral metronidazole and oral vancomycin) was also similar. Laboratory-confirmed isolation of S. boulardii from sterile body sites was identified in five patients during the protocol versus only one case in the pre-protocol years.

scholarly journals Impact of an Automatic Hospital Probiotic Protocol on Clostridium difficile Infection Rates and Antibiotic Usage Patterns

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S2-S2
Author(s):  
Douglas Slain ◽  
Amy Georgulis ◽  
Ronald Dermitt ◽  
Laura Morris ◽  
Stephen Colodny
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Community Hospital ◽  
Pcr Analysis ◽  
Infection Rates ◽  
Oral Vancomycin ◽  
Protocol Implementation ◽  
Increased Risk ◽  
Before And After ◽  
Oral Metronidazole

Abstract Background The use of probiotics in hospitalized patients ordered antibiotics has been associated with a preventative effect against Clostridium difficile infection (CDI) in a few small studies and meta-analyses. Starting in 2014, all adult patients admitted to our 330-bed community hospital who were started on an antibiotic automatically received a course of the probiotic Saccharomyces boulardii (SB). Our study provides a much larger experience with which to assess the preventative use of SB in patients receiving concomitant antibiotics. Methods Rates of CDI were compared during the 3-year periods before and after the automatic SB protocol implementation. CDI infection rates using ICD-9 code and CDC hospital-associated infection (HAI) definitions were compared. The use of CDI treatment agents (oral vancomycin and oral metronidazole) expressed in DDD/1,000 patient-days, and rates of SB infections/cultures were also assessed. All rates were standardized per hospital census. Clostridium difficile laboratory detection was performed by PCR analysis throughout the study period. Results Case rates of CDI using ICD-9 or CDC HAI definitions did not differ before and after protocol implementation (P = 0.165 and P = 0.521, respectively). The use of CDI treatment antibiotics were also similar; oral metronidazole (P = 0.269), oral vancomycin (P = 0.938), total CDI agents (P = 0.633). Positive specimen cultures for SB where identified in two patients prior to protocol and in 27 patients during the protocol years. Actual SB infections from sterile body sites were identified in five patients during the protocol vs. only one case in the pre-protocol years (P = 0.035). The average yearly cost of SB prophylaxis was $63,000. Conclusion In our global assessment of this data, the use of an automatic SB protocol at our community hospital was not associated with a protective effect against CDI. The use of SB was associated with an increased risk of SB infections. Further study of SB and other probiotic formulations for CDI prevention are warranted. Disclosures All authors: No reported disclosures.

Clostridium difficile—Associated Diarrhea, an Emerging Epidemic: Therapeutic Options

2007 ◽  
Vol 20 (4) ◽  
pp. 347-353
Author(s):  
Christopher R. Emerson
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Treatment Options ◽  
Infectious Diarrhea ◽  
First Line ◽  
Oral Vancomycin ◽  
Considerable Morbidity ◽  
Clostridium Difficile Associated Diarrhea ◽  
Pharmacologic Agents ◽  
Oral Metronidazole

Clostridum difficile—associated disease (CDAD) is the leading cause of infectious diarrhea and is associated with considerable morbidity and mortality. The incidence is estimated to range from 3.4 to 8.4 cases per 1000 hospital admissions, and it has become a growing problem at many institutions. Treatment options for CDAD are limited due to a paucity of new pharmacologic agents and studies examining other potential treatments. Historically oral metronidazole and oral vancomycin have been used as first-line agents in the treating CDAD, however recent reports of treatment failure and recurrence with these agents have surfaced. These reports illustrate a need for novel pharmacologic agents and a thorough review of currently available agents that may have activity against C difficile. Available data on the treatment of CDAD were extracted and reviewed to outline the appropriate management of CDAD.

scholarly journals 1110. A multicenter Evaluation of Outcomes Associated With Oral Vancomycin Dose in Patients With Clostridium difficile Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S333-S333
Author(s):  
Monique Bidell ◽  
Gregory Novak ◽  
Gurkirat Singh ◽  
Benjamin Bratek ◽  
Odirichukwu Duru ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Standard Dose ◽  
Univariate Analysis ◽  
Fecal Microbiota ◽  
P Value ◽  
High Dose ◽  
Oral Vancomycin ◽  
Symptomatic Infection ◽  
Fecal Microbiota Transplant

Abstract Background Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality. IDSA guidelines recommend oral vancomycin (VAN) for the treatment of CDI, although doses used in practice vary substantially. The purpose of this study was to determine differences in outcomes between patients treated with high dose (HD; ≥250 mg four times daily [QID]) vs. standard dose (SD; 125 mg QID) VAN for CDI. Methods This multicenter study evaluated patients at two hospitals in Albany, NY diagnosed with CDI and treated with oral VAN between January 2013 and August 2017. Hospitalized patients were included if: age ≥18 years, positive C. difficile toxin polymerase chain reaction (PCR), symptomatic infection (e.g., new onset or increased frequency of loose stools), and received ≥48 hours of VAN QID. Patients were excluded if: received ≥48 hours of metronidazole prior to VAN initiation, VAN per rectum, required surgical intervention ≤48 hours from PCR, had a history of fecal microbiota transplant, received ≥1 dose of fidaxomicin or tigecycline prior to or within 48 hours from PCR, or died ≤48 hours from PCR. The primary outcome was 90-day CDI recurrence; secondary outcomes included 30-day all-cause mortality and 90-day readmission. Variables with a P-value <0.2 in univariate analysis were evaluated in multivariate (MV) analyses. Results Four hundred fifty-eight patients were included (site 1: 270; site 2: 188). Two hundred twenty-four patients received SD VAN (48.9%); 234 received HD VAN [250 mg QID: 199 (43.5%); 500 mg QID: 35 (7.6%)]. Baseline demographics were similar between groups. Patients treated with HD were more likely to present with colitis (19.2 vs. 29.5%, P = 0.01) and have higher infection severity based on IDSA (P < 0.01), Zar (P < 0.01), and American College of Gastroenterology (P < 0.02) criteria. Modified APACHE II scores were similar between SD and HD groups (median: 12.2 vs. 12.9, P = 0.17). MV analysis identified no difference in 90-day recurrence with HD (OR 1.65, P = 0.13) after controlling for solid tumor cancers, immunosuppression, and IDSA severity. Similarly, no significant differences between SD and HD were observed for 30-day mortality and 90-day readmission. Conclusion No differences in recurrence, mortality, or readmission were identified between SD and HD oral VAN for the treatment of CDI, though HD VAN patients primarily received 250 mg QID. Disclosures All authors: No reported disclosures.

Patterns and determinants of chemotherapy-associated Clostridium difficile infection among cancer patients in the United States: A population-based study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19111-e19111
Author(s):  
Pramit Nadpara
Keyword(s):  
Prostate Cancer ◽  
Multiple Myeloma ◽  
Clostridium Difficile ◽  
Elderly Patients ◽  
Cancer Patients ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clostridium Difficile Infection ◽  
The United States ◽  
Chemotherapeutic Agents

e19111 Background: Elderly cancer patients comprise a population that is vulnerable for Clostridium difficile infection (CDI). In addition to the frequent hospitalizations, the administration of chemotherapeutic agents has been associated with the development of CDI. The objective of this study was to identify the patterns and determinants of chemotherapy-associated CDI (Chemo-CDI), in a nationwide sample of elderly patients. Methods: We used NCI’s Surveillance, Epidemiology, and End Results registry linked Medicare (SEER-Medicare) 2007-2012 files. We included patients’ aged ≥65 year, with diagnosis of lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia during 2008-2011. We excluded those not receiving chemotherapy, with non-continuous Medicare enrollment, or HMO enrollment. Chemotherapy receipt was identified using appropriate ICD-9/HCPCS/CPT codes. Incidence of CDI following chemotherapy were determined by identifying any claim with primary/secondary diagnosis of CDI during the two-month follow-up period. Recurrent Chemo-CDI was identified by presence of any claim that was > 2 weeks and ≤8 weeks from the index CDI diagnosis date. Covariates including antibodies/proton pump inhibitors usage were captured and included in the analysis. Chi-square tests, and hierarchical generalized logistic models were conducted to identify determinants of Chemo-CDI. Results: We identified 41,470 elderly patients with lung/breast/ovarian/colorectal/prostate cancer, or lymphoma/multiple myeloma/leukemia diagnosis during the study years. While few (266) patients developed Chemo-CDI within one year of diagnosis, more than 50% (136) of those patients developed recurrent Chemo-CDI. Patient characteristics were not associated with risk of developing Chemo-CDI, however, significant differences were observed in antibiotics/proton pump inhibitors exposure across all cancer types (p < 0.001). Treatment for Chemo-CDI mostly comprised of Metronidazole and oral Vancomycin. Conclusions: While the incidence of Chemo-CDI is lower among patients receiving chemotherapy, the rate of recurrent Chemo-CDI was significantly higher. Strategies to prevent CDI recurrence in this population are therefore warranted. Future studies should also explore the association between increased disease burden and comorbidity, and the risk of developing Chemo-CDI.

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