scholarly journals 2347. Impact of Multidisciplinary Review of Clostridioides difficile Testing

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S807-S807
Author(s):  
Jena Foreman ◽  
Neha Belter ◽  
Stephanie Thannum
Keyword(s):  
Tube Feeding ◽  
Cost Savings ◽  
Dna Amplification ◽  
Antibiotic Use ◽  
The United States ◽  
Primary Objective ◽  
Labor Costs ◽  
Clostridioides Difficile ◽  
Significant Difference ◽  
Baseline Characteristics

Abstract Background Minimizing Clostridioides difficile infections (CDI) is an important patient safety goal due to significant cost and disease burden with CDI causing 15,000 deaths annually in the United States. Diagnosis of CDI is complicated when DNA amplification assay will return positive for both colonization and active infection of C. difficile, so testing clinically symptomatic patients with at least 3 loose stools per day is paramount to obtaining accurate reporting rates and starting proper treatment for CDI. Methods Due to economic considerations, the study was a single-center retrospective review of inpatients ≥ 18 years old who had C. difficile tests ordered from November 2017 to February 2019. Baseline characteristics collected include age, sex, white blood cell (WBC) count, fever, past C. difficile infections, recent antibiotic use, recent laxative use, and tube feeding status. Data were analyzed using descriptive statistics. The primary objective of this study was to look at the appropriateness of C. difficile tests pre and post-implementation of multidisciplinary review. Criteria for appropriateness of testing included 3 or more loose stools in addition to one additional factor including fever, elevated WBCs, immunocompromised status, or severe sepsis/septic shock. Secondary objectives include evaluating hospital-onset CDI rates and cost analysis. Results Baseline characteristics were similar between the two groups with the exception of statistically fewer patients with 3 or more liquid stools found in the post-implementation group (P = 0.0003). After implementation of a multidisciplinary review, the number of C. difficile tests ran significantly declined from 79% to 56% (P = 0.0001). The number of negative tests also were significantly reduced from 60% to 43% (P = 0.0001), with patients who had less than 3 stools per day being tested less frequently in the post-implementation group. Inappropriate test avoidance resulted in an annual savings of $1,550 in testing supplies alone, not including isolation or labor costs. There was no significant difference in hospital-onset CDI. Conclusion Implementation of a multidisciplinary review of C. difficile testing avoids clinically inappropriate tests and results in cost savings with no effect on incidence of hospital-onset CDI. Disclosures All authors: No reported disclosures.

scholarly journals Infection Preventionist Run Clostridioides difficile Testing Diagnostic Stewardship Protocol- Experience From a Rural Community Hospital

2020 ◽  
Vol 41 (S1) ◽  
pp. s484-s485
Author(s):  
Raghavendra Tirupathi ◽  
Ruth Freshman ◽  
Norma J Montoy ◽  
Melissa Gross
Keyword(s):  
Cost Savings ◽  
Antibiotic Use ◽  
First Year ◽  
Multiple Parameters ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Commercial Company ◽  
Surgical History ◽  
Test Ordering ◽  
Infection Preventionists

Background: Distinguishing active Clostridioides difficile infection (CDI) from asymptomatic colonization remains a challenging task in the era of PCR testing. Inappropriate testing leads to overtesting and overdiagnosis, inadvertent treatment, and isolation in addition to laboratory identified (LabID) events, leading to increased incidence to hospital-onset CDI (HO-CDI). The institution has a nurse-driven C. difficile test ordering protocol, and we noted a significant increase in the HO-CDI incidence in 2017 due to inappropriate testing, with rates as high as 0.94 per 1,000 patient days. Methods: In September 2017, a multidisciplinary team reviewed and initiated algorithm-based testing with mandatory audit and review by infection preventionists (IPs) under the guidance of an ID physician of all ordered tests. They reviewed the adequacy and legitimacy of order for multiple parameters, including minimum 3 loose stools in 24 hours, use of laxatives in last 24 hours, consistency of the sample, presence of at least 1 clinical parameters (ie, fever, abdominal pain, leukocytosis, sepsis, or septic shock), recent or concomitant antibiotic use, recent PCR testing in the last 14 days, and chart review for medical and/or surgical history. The IPs served as the gatekeepers to testing and rejected the samples that were deemed inappropriate. Ambiguous cases were discussed with the ID specialist. On the microscope lab side, all specimens sent were batched to be run twice a day at 8:30 a.m. and 2:30 p.m., and testing was performed only on the samples cleared by infection preventionists. Results: The number of PCR tests completed in the comparison quarter of 2016 was 220, which decreased to 157 tests in 2017 with a reduction of 28%. After a full year of implementation of the diagnostic stewardship protocol, the number of completed PCR tests decreased to 626 from 940 PCR tests in 2016, with an overall 34% decrease in testing. In the year following the implementation of diagnostic stewardship, HO-CDI decreased from 60 events in 2017 to 43 events in 2018, with a reduction of 28%. Subsequently, HO-CDI further decreased in 2019 from 43 to 28, with a reduction of 35%. Since the implementation of the project in 2017, HO-CDIs have decreased by 54% overall. The reduction in 314 C. difficile PCR tests in the first year led to a savings of $8,300 in laboratory testing supplies. The reduction of HO CDI by 17 led to cost avoidance of $293,420. Conclusions: Our experience shows that the IP-run diagnostic stewardship program was highly successful in streamlining testing, with cost savings on several fronts.Funding: NoneDisclosures: NoneDisclosures:Commercial Company : If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the funding company.DisagreeRaghavendra Tirupathi

Hospital-level high-risk antibiotic use in relation to hospital-associated Clostridioides difficile infections: Retrospective analysis of 2016–2017 data from US hospitals

2019 ◽  
Vol 40 (11) ◽  
pp. 1229-1235 ◽  
Author(s):  
Ying P. Tabak ◽  
Arjun Srinivasan ◽  
Kalvin C. Yu ◽  
Stephen G. Kurtz ◽  
Vikas Gupta ◽  
...  
Keyword(s):  
High Risk ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
The United States ◽  
Fourth Generation ◽  
Teaching Hospitals ◽  
Clostridioides Difficile ◽  
Positive Stool ◽  
Days Of Therapy ◽  
Assay Result

AbstractObjective:Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).Methods:We analyzed 2016–2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins, fluoroquinolones, carbapenems, and lincosamides. A CDI case was a positive stool C. difficile toxin or molecular assay result from a patient without a positive result in the previous 8 weeks. Hospital-associated (HA) CDI cases included specimens collected >3 calendar days after admission or ≤3 calendar days from a patient with a prior same-hospital discharge within 28 days. We used the multivariable Poisson regression model to estimate the relative risk (RR) of high-risk antibiotic use on HA CDI, controlling for confounders.Results:The median days of therapy for high-risk antibiotic use was 241.2 (interquartile range [IQR], 192.6–295.2) per 1,000 days present; the overall HA CDI rate was 33 (IQR, 24–43) per 10,000 admissions. The overall correlation of high-risk antibiotic use and HA CDI was 0.22 (P = .003), and higher correlation was observed in teaching hospitals (0.38; P = .002). For every 100-day (per 1,000 days present) increase in high-risk antibiotic therapy, there was a 12% increase in HA CDI (RR, 1.12; 95% CI, 1.04–1.21; P = .002) after adjusting for confounders.Conclusions:High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI.

scholarly journals Cervical Arterial Fibromuscular Dysplasia in a Biethnic Population: A Retrospective Study in the U.S.–Mexican Border

2016 ◽  
Vol 26 (04) ◽  
pp. 253-258 ◽  
Author(s):  
Gustavo Rodriguez ◽  
Tatiana Chacon-Quesada ◽  
Gavito-Higuera Jose ◽  
Salvador Cruz-Flores ◽  
Alberto Maud ◽  
...  
Keyword(s):  
Cigarette Smoking ◽  
Intracranial Aneurysm ◽  
Fibromuscular Dysplasia ◽  
Positive Association ◽  
The United States ◽  
Vascular Events ◽  
Arterial Lesions ◽  
Significant Difference ◽  
History Of ◽  
Baseline Characteristics

Background There have been studies trying to characterize Fibromuscular Dysplasia (FMD); however, most of them are based in mainly non-Hispanic sample. The objective of this study is to better understand the epidemiology and clinical characteristics of craniocervical FMD in the Hispanic population. Methods We retrospectively reviewed the cerebral angiograms performed in our center in a period of 3.5 years under any indication looking for angiographic patterns of FMD. Exclusion criteria consisted of cases in which the first angiogram was done when the patients were younger than 18 years. Patients were subdivided based on those with FMD and those without it for baseline characteristics and were looked for any associations. We further compared the same baseline characteristics among Hispanic FMD and non-Hispanic FMD population. A chart review was conducted looking for clinical features and vascular events. Results We analyzed 448 angiograms among patients younger than 18 years. We identified 47 patients with evidence of FMD involving the cervical arteries and 401 patients without FMD. Of the 47 patients with FMD in our neuroendovascular registry, we found that 76.6% were women and 57.4% were Hispanics. There was no statistical significant difference when comparing the variables across ethnicities, except history of cigarette smoking and dyslipidemia. The most common associated supra-aortic arterial lesions seen in the FMD group were intracranial aneurysm and arterial dissections. We then used same variables to compare Hispanic FMD with non-Hispanic FMD. We have found that there has been a positive association of cigarette smoking and dyslipidemia with FMD (p ≤ 0.05). Conclusion Our study suggests that FMD affecting the carotid and vertebral arteries has similar demographic pattern across ethnicities in the United States. In Hispanics, the disease appears to have a predilection for women and history of cigarette smoking. Intracranial aneurysm and arterial dissection were the most commonly associated arterial lesions.

scholarly journals Raja 42, a novel gamma lactam compound, is effective against Clostridioides difficile

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257143
Author(s):  
Alexis Fong ◽  
Megan Ross ◽  
Justin Boudreau ◽  
Reza Nokhbeh ◽  
Kim Tilbe ◽  
...  
Keyword(s):  
United States ◽  
Therapeutic Agent ◽  
The United States ◽  
Primary Objective ◽  
Clinical Isolates ◽  
High Rate ◽  
Clostridioides Difficile ◽  
Lactam Antibiotic ◽  
Enteric Infections ◽  
Hospital Acquired

Clostridioides difficile infection (CDI) is the primary cause of hospital-acquired diarrhea, and responsible for over 500,000 enteric infections a year in the United States alone. Although most patients with CDI are successfully treated with metronidazole or vancomycin, the high rate of recurrence is still a serious problem, in which case these antibiotics are usually not very effective. The primary objective of this research is to develop a potentially effective therapeutic agent against C. difficile that are resistant to metronidazole or vancomycin. The susceptibility to metronidazole and vancomycin was examined with 194 C. difficile clinical isolates. Sixty of these isolates chosen based on a variety of criteria were examined for their susceptibility against the 4-chloro-1-piperidin-1ylmethyl-1H-indole-2,3-dione compound (Raja 42), a novel isatin–benzothiazole analogue containing a gamma-lactam structure, as we previously found that this novel compound is effective against a variety of different bacteria. Most of the 60 isolates were resistant to ceftriaxone and ciprofloxacin, raising the possibility that they might have been exposed previously to these or structurally similar antibiotics (e.g., β-lactam and quinolone compounds). Among the isolates, 48 (80%) and 54 (90%) were susceptible to metronidazole and vancomycin, respectively. Raja 42 was found to be effective against most of the isolates, especially so against metronidazole-resistant C. difficile. Most importantly, five isolates that show resistance to metronidazole and vancomycin were sensitive to Raja 42. Thus, Raja 42, a gamma lactam antibiotic, has the potential to effectively control C. difficile strains that are resistant to metronidazole and vancomycin.

scholarly journals 2389. Assessing the Time Course of Proton Pump Inhibitor Use and Clostridioides difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S825-S825
Author(s):  
Katherine Panagos ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Erik von Rosenvinge ◽  
Emily Heil
Keyword(s):  
Proton Pump ◽  
Time Course ◽  
Conditional Logistic Regression ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Significant Difference ◽  
Clostridioides Difficile Infection ◽  
The Impact

Abstract Background Proton pump inhibitors (PPIs) are a known risk factor for Clostridioides difficile infection (CDI) and recurrence, even in the absence of antibiotic use. No studies have specifically assessed the increased risk for CDI based on PPI duration, given that PPIs are frequently newly prescribed during hospitalizations and infrequently discontinued, even when CDI has occurred. The aim of this project was to assess the time course of PPI utilization and risk of CDI. Methods We conducted a retrospective matched case–control study comparing patients who developed CDI (cases) with patients who did not develop CDI (controls, matched on age, gender, date of admission and hospital location) from a cohort of patients with a C.difficile PCR test order from an academic medical center. Patient charts were reviewed for PPI use prior to the date of the positive test and whether the PPI was started in the hospital or as a home medication (>30d, 30–90d, 90–180d, >180d). The primary comparison was odds of PPI use between cases and controls using conditional logistic regression adjusted for antibiotic exposure (SAS 9.4, Cary, NC). Results A total of 348 patients were included in the study, 174 cases and 174 matched controls. 65% of patients in the study received a PPI, 85% a PPI or H2 blocker and 95% of patients received antibiotics during their admission. Patients on PPIs as home medications were not at an increased risk of CDI (OR = 1.08 (95% CI 0.60–1.93)) compared with those not on PPIs. Patients whose PPIs were initiated in the hospital were at increased risk of CDI compared with those not on PPIs (OR = 1.4 (95% CI 0.81–2.41)). No significant difference was observed across time periods of PPI use prior to admission and development of CDI. Conclusion Patients who started PPIs during inpatient stays were at a higher risk of developing CDI than patients not exposed to PPIs. However, PPI use was not found to be significantly associated with CDI in this analysis, regardless of the time or duration of PPI prescription. The results may be confounded by the high frequency of PPI use and concomitant antibiotic use in both cases and controls. Further study is needed to evaluate the impact of short-course PPI prescriptions in inpatient settings on CDI. Disclosures All authors: No reported disclosures.

Impact of pharmacist-led selective audit and feedback on outpatient antibiotic prescribing for UTIs and SSTIs

2021 ◽  
Author(s):  
Patricia W Choi ◽  
Jessica A Benzer ◽  
Joel Coon ◽  
Nnaemeka E Egwuatu ◽  
Lisa E Dumkow
Keyword(s):  
Primary Care ◽  
The United States ◽  
Empiric Therapy ◽  
Primary Objective ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Feedback Process ◽  
Clostridioides Difficile ◽  
The Individual ◽  
Tract Infections

Abstract Purpose An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission in 2016 implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices. Methods A retrospective, quasi-experimental study was conducted to evaluate antibiotic prescribing for patients treated for a UTI or SSTI at 2 primary care offices (a family medicine office and an internal medicine office). The primary objective was to compare the rate of appropriate antibiotic prescribing to patients treated before implementation of a pharmacist-led audit-and-feedback process for reviewing antibiotics prescribed for UTIs and SSTIs (the pre-ASP group) and patients treated after process implementation (the post-ASP group). Total regimen appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy guidelines. Secondary objectives included comparing rates of infection-related revisits and Clostridioides difficile infection between groups. Results A total of 400 patients were included in the study (pre-ASP gropu, n = 200; post-ASP group, n = 200). The rate of total antibiotic prescribing appropriateness improved significantly, from 27.5% to 50.5% (P < 0.0001), after implementation of the audit-and-feedback process. There were also significant improvements in the post-ASP group vs the pre-ASP period in the individual components of regimen appropriateness: appropriate drug (70% vs 53%, P < 0.001), appropriate duration (83.5% vs 57.5% , P < 0.001), and appropriate therapy indication (98% vs 94% , P = 0.041). There were no significant between-group differences in other outcomes such as rates of adverse events, treatment failure, C. difficile infection, and infection-related revisits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy was demonstrated to achieve significant improvement in outpatient antibiotic prescribing for UTI and SSTI.

scholarly journals The Great Masquerade: Identification of Clinically Relevant Clostridioides difficile Infections

2020 ◽  
Vol 41 (S1) ◽  
pp. s405-s405
Author(s):  
Emily Sickbert-Bennett ◽  
Lisa Stancill ◽  
Lauren DiBiase ◽  
Kevin Alby ◽  
David Jay Weber
Keyword(s):  
Severe Disease ◽  
The United States ◽  
Clinical Parameter ◽  
Loose Stool ◽  
Academic Hospital ◽  
Testing Methodology ◽  
Clostridioides Difficile ◽  
Significant Difference ◽  
Polymerase Chain ◽  
The Ideal

Background: Despite clear guidance for appropriate testing of symptomatic patients for Clostridioides difficile testing (McDonald et al), the ideal testing methodology remains unresolved. Laboratories currently use different algorithms that incorporate enzyme immunoassay (EIA) testing for toxin, glutamate dehydrogenase (GDH) antigen, and polymerase chain reaction (PCR) testing in combination or as a single test. At UNC Hospitals, a large academic hospital with nearly 1,000 beds in the ninth most populous state in the United States, patients are currently tested by an EIA test for toxin and GDH antigen first, and discordant toxin/GDH results are referred for PCR testing. Previous studies have demonstrated that detection of toxin by EIA is a better predictor of C. difficile infection (CDI) complications (Polage et al). Methods: We investigated all patients who were tested for C. difficile from July 2018 to June 2019. Within each testing methodology and result, we assessed the percentage of patients with at least 3 loose stools documented within a 24-hour period, percentage with a severe episode based on white blood cell (WBC) counts >15,000 cells/mL, or percentage with a serum creatinine level >1.5 mg/dL. Fisher-type confidence intervals were calculated for each proportion. Results: Patients positive for C. difficile by the EIA method had 66.9% appropriate loose stool documentation (95% CI, 57.4%–75.5%), whereas patients with EIA-indeterminate (toxin negative, GDH positive) and positive by only PCR had 49.7% appropriate loose stool documentation (95% CI, 42.7%–56.8%). C. difficile patients that tested negative had 48.1% appropriate loose stool documentation (95% CI, 46.0–50.2%). In addition, patients positive by the EIA method had nearly double the proportion of severe disease by WBC or creatinine criteria compared to patients who were either positive by PCR or who tested negative (Table 1). Conclusions: Patients positive for C. difficile by the EIA method were statistically more likely to meet criteria for loose stool documentation. There was no statistically significant difference between patients that tested positive only by PCR or who tested negative. The percentage of patients with severe episode criteria based on WBC or creatinine was nearly doubled between those who tested positive by EIA and PCR (20% vs 10%), although this finding was not statistically significant. The percentage with severe disease (WBC or creatinine) was nearly identical among patients who were positive by PCR and who tested negative. These findings demonstrate that documentation of loose stool is a more sensitive indicator of toxin detection than either clinical parameter, reinforcing the importance of stool documentation in evaluating patients for C. difficile testing.Funding: NoneDisclosures: None

scholarly journals Potential Cost Savings Associated with Targeted Substitution of Current Guideline-Concordant Inpatient Agents with Omadacycline for the Treatment of Adult Hospitalized Patients with Community-Acquired Bacterial Pneumonia at High Risk for Clostridioides difficile Infections: Results of Healthcare-Decision Analytic Model from the United States Hospital Perspective

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1195
Author(s):  
Thomas Lodise ◽  
Mauricio Rodriguez ◽  
Surya Chitra ◽  
Kelly Wright ◽  
Nimish Patel
Keyword(s):  
Bacterial Pneumonia ◽  
Cost Savings ◽  
The United States ◽  
Hospitalized Patients ◽  
Decision Analytic Model ◽  
Current Guideline ◽  
Analytic Model ◽  
Healthcare Decision ◽  
Model Population ◽  
Clostridioides Difficile

Introduction: Approximately 3% of hospitalized patients with community-acquired bacterial pneumonia (CABP) develop healthcare-associated Clostridioides difficile infection (HCA-CDI). The validated Davis risk score (DRS) indicates that patients with a DRS ≥ 6 are at an increased risk of 30-day HCA-CDI. In the phase 3 OPTIC CABP study, 14% of CABP patients with DRS ≥ 6 who received moxifloxacin developed CDI vs. 0% for omadacycline. This study assessed the potential economic impact of substituting current guideline-concordant CABP inpatient treatments with omadacycline in hospitalized CABP patients with a DRS ≥ 6 across US hospitals. Methods: A deterministic healthcare-decision analytic model was developed. The model population was hospitalized adult CABP patients with a DRS ≥ 6 across US hospitals (100,000 patients). In the guideline-concordant arm, 14% of CABP patients with DRS ≥ 6 were assumed to develop an HCA-CDI, each costing USD 20,100. In the omadacycline arm, 5 days of therapy was calculated for the entire model population. Results: The use of omadacycline in place of guideline-concordant CABP inpatient treatments for CABP patients with DRS ≥ 6 was estimated to result in cost savings of USD 55.4 million annually across US hospitals. Conclusion: The findings of this simulated model suggest that prioritizing the use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may potentially reduce attributable HCA-CDI costs. The findings are not unique to omadacycline and could be applied to any antibiotic that confers a lower risk of HCA-CDI relative to current CABP inpatient treatments.

scholarly journals 1492. Targeted Substitution of Omadacycline in Place of Standard of Care for CABP Treatment is Associated with a Risk Reduction of Clostridioides difficile Infection and Financial Cost Savings in the Acute Care Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S747-S748
Author(s):  
Mauricio Rodriguez ◽  
Surya Chitra ◽  
Kelly Wright ◽  
Thomas Lodise
Keyword(s):  
High Risk ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
First Episode ◽  
Base Case ◽  
Decision Analytic Model ◽  
Potential Cost ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

Abstract Background Real-world evidence studies indicate that around 3% of hospitalized patients with community-acquired pneumonia (CAP) develop Clostridioides difficile infection (CDI; Chalmers et al, J Infect 2016;73:45–53). Factors associated with increased CDI risk include Davis risk score (DRS) ≥ 6, and treatment with high-risk antibiotics such as fluroquinolones (FQ) and ceftriaxone (CTX). Omadacycline (OMC) is indicated for the treatment of community-acquired bacterial pneumonia (CABP) and has demonstrated a low propensity to induce CDI in preclinical and clinical studies. In the phase 3 OPTIC study, 2% of CABP patients who received moxifloxacin (MOX) developed CDI vs 0% for OMC (Stets et al, N Engl J Med 2019;380:517–27); 14% of MOX patients with DRS ≥ 6 developed CDI vs 0% in the OMC group (Table 1; Figure 1). We assessed the economic impact of substituting current CABP treatment (FQ and CTX) with OMC for hospitalized CABP patients with DRS ≥ 6. Table 1 Figure 1 Methods A deterministic healthcare-decision analytic model was performed. Only excess costs associated with each treatment were considered. Base-case model inputs were: yearly CAP admission in US, prevalence of CAP patients with DRS ≥ 6, CDI risk for CAP patients with DRS ≥ 6 with current CABP treatments, CDI costs (initial and recurrent), and OMC cost (Table 2). Efficacy and safety of treatments were assumed to be equal. CDI risk of 0% was assumed for OMC. Costs are reported as USD. Table 2 Results For patients with CABP, total CDI costs were $738M, with first-episode costs of $489M plus recurrence costs of $249M. The cost of 5 days (mean hospital length of stay for CABP) of OMC was $207M. Use of OMC for the estimated 100,000 CABP patients with DRS ≥ 6 would result in a potential cost saving of up to $531M for this patient population, assuming CDI risk of 0% with OMC. As CDI is a risk from any antibiotic use, cost savings can be achieved when OMC is used in place of high-risk antibiotics patients when CDI risk rates exceed 3.9%. Conclusion Our findings suggest prioritizing use of omadacycline over current CABP treatments in hospitalized CABP with a DRS ≥ 6 may substantially reduce attributable CDI costs. These results can serve as a basis for stewardship interventions to reduce hospital CDI rates and associated costs. Disclosures Mauricio Rodriguez, PharmD, BCPS, BCCCP, BCIDP, Paratek Pharmaceuticals, Inc. (Employee) Surya Chitra, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Kelly Wright, PharmD, Paratek Pharmaceuticals, Inc. (Employee, Shareholder) Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant)

scholarly journals Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?

2021 ◽  
Vol 1 (S1) ◽  
pp. s43-s43
Author(s):  
Armani Hawes ◽  
Payal Patel ◽  
Angel Desai
Keyword(s):  
Infection Prevention ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
The United States ◽  
Single Center ◽  
Interrupted Time Series Analysis ◽  
Strict Adherence ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Washtenaw County

Background: The COVID-19 pandemic has underscored the importance of ongoing infection prevention efforts. Increased adherence to infection prevention recommendations, increased antibiotic use, improved hand hygiene, and correct donning and doffing of personal protective equipment may have influenced healthcare-associated infections (HAIs) in the United States during the pandemic. In this study, we investigated testing for Clostridioides difficile infection (CDI) and incidence during the initial surge of the pandemic. We hypothesized that strict adherence to contact precautions may have resulted in a decreased incidence of CDI in hospitalized patients during the first peak of the COVID-19 pandemic and that CDI testing may have increased even in the absence of directed diagnostic stewardship efforts. Methods: We conducted a single-center, retrospective, observational study at the Veterans’ Affairs (VA) Hospital in Ann Arbor, Michigan, between January 2019 and June 2020. We compared data on CDI tests from January 2019 through February 2020 to data from March 2020 (the admission of the first patient with COVID-19 at our institution) through June 2020. Pre-peak and peak periods were defined by confirmed cases in Washtenaw County. No novel diagnostic or CDI-focused stewardship interventions were introduced by the antimicrobial stewardship program during the study period. An interrupted time series analysis was performed using STATA version 16.1 software (StataCorp LLC, College Station, TX). Results: There were 6,525 admissions and 34,533 bed days between January 1, 2019, and June 30, 2020. Also, 900 enzyme immunoassay (EIA) tests were obtained and 104 positive cases of CDI were detected between January 2019 and June 2020. A statistically significant decrease in EIA tests occurred after March 1, 2020 (the COVID-19 peak in our region) compared to January 1, 2019–March 1, 2020 (Figure 1). After March 1, 2020, the number of EIA tests obtained decreased by 10.2 each month (95% CI, −18.7 to −1.7; P = .02). No statistically significant change in the incidence of CDI occurred. The use of antibiotics that were defined as high risk for CDI increased in the months of April–June 2020 (Figure 2). Conclusions: In this single-center study, we observed a stable incidence of CDI but decreased testing during the first peak of the COVID-19 pandemic. Understanding local HAI reporting is critical because changes in HAI reporting structures and exemptions during this period may have affected national reporting. Further research should be undertaken to investigate the effect of COVID-19 on other HAI reporting within the US healthcare system.Funding: NoDisclosures: None

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