scholarly journals 2413. Assessment of compliance with Clostridioides difficile prophylaxis guideline and its efficacy on secondary prophylaxis and reducing hospital-onset Clostridioides difficile infections.

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S833-S833
Author(s):  
Nikunj M Vyas ◽  
Cindy Hou ◽  
Todd P Levin
Keyword(s):  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Secondary Prophylaxis ◽  
Primary Objective ◽  
Control Group ◽  
Inpatient Mortality ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Prophylaxis Guideline

Abstract Background One of the complications of Clostridium difficile infection (CDI) is the risk of recurrence, particularly in high-risk patients who are exposed to broad-spectrum antibiotics (BSA). Antimicrobial stewardship program at our institution developed Clostridium difficile prophylaxis (CDP) guidelines. Purpose of this study was to evaluate the compliance to this guideline and evaluate the efficacy of it preventing recurrent CDI. Methods This was an IRB approved retrospective study performed at a 607-bed community health system between 2014–2016. Patients were included if they were ≥18 years old and admitted for > 24 hours on BSA with history of CDI in last 6 months. CDI prophylaxis was provided with oral vancomycin 125 PO BID. Patients were excluded if they had active CDI receiving metronidazole or treatment doses of oral vancomycin. Patients were compared in two cohorts: Study group which was patients in CDP group which were matched to control group. The primary objective of the study was to evaluate the compliance of CDP guidelines and incidence of hospital-onset CDI (HO-CDI) between CDP group and control group. The secondary objective focused on all-cause inpatient mortality and 30-day readmission between two groups. Results There were total of 72 patients reviewed and 47 patients met the inclusion criteria for CDP group which were matched with control group. Most common type of infection and BSA were pnuemonia (26%) and broad-spectrum cephalosporins (31%), respectively. CDP guidelines compliance was measured at 65%. The incidence of HO-CDI/10000 patient-days during the admission was lower in CDP group compared with control group (2.02 vs 5.4 per 10,000 PD, P = 0.03). No differences were seen in all-cause inpatient mortality and 30-day readmission between two groups. Forty-five percent of patients suffered from CDI < 3 months prior to admission. The most common dose of oral vancomycin was 125 mg PO BID. Conclusion Patients in CDP group had a lower incidence of developing HO-CDI compared with control group. Overall compliance with CDP guidelines was higher than expected. No difference was seen in all-cause inpatient mortality and 30-day readmission between two groups. Oral vancomycin 125 mg PO BID shows promising results as a secondary prophylaxis in patients receiving BSA. Disclosures All authors: No reported disclosures.

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.

Taking on Clostridioides difficile

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

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

scholarly journals Prolonged oral vancomycin for secondary prophylaxis of relapsing Clostridium difficile infection

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kevin Zhang ◽  
Patricia Beckett ◽  
Salaheddin Abouanaser ◽  
Vida Stankus ◽  
Christine Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Secondary Prophylaxis ◽  
Oral Vancomycin

scholarly journals Efficacy of Oral Vancomycin, Oral Metronidazole, or IV Metronidazole Prophylaxis at Reducing the Risk of Clostridium difficile Recurrence

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S384-S384
Author(s):  
Matthew O’Connell ◽  
Judianne Slish ◽  
Mark Shelly
Keyword(s):  
Retrospective Study ◽  
Clostridium Difficile ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Secondary Prophylaxis ◽  
Oral Vancomycin ◽  
Recurrence Rates ◽  
The Difference

Abstract Background Secondary prophylaxis (SP) for Clostridium difficile infection (CDI) with oral vancomycin or oral/IV metronidazole when initiating antibiotics is common, though few studies are available to support this practice. The purpose of this study was to assess the efficacy of prophylaxis within a year of index CDI. Methods This retrospective chart review looks at subsequent courses of antibiotics and CDI in patients with initial positive CDI testing in 2013–16. A positive CDI test within 90 days of antibiotics was a recurrence. The use of antibiotics for SP was noted, along with other factors associated with CDI relapse. Non-parametric and exact tests were used for univariate analysis. These variables were included in a multivariate proportional hazards model. Results We found 597 antibiotic episodes in 230 patients. 130 episodes (21.8%) received SP. The difference of recurrence rates with and without antibiotics, 9.2 % vs 10.7%, was not statistically significant. No difference was seen when metronidazole was used, but vancomycin SP reduced the rate to 7.5% (6/80, P = 0.45). Probiotics were associated with a higher rate of recurrence (16.7 vs. 8.9%, P = 0.025). Proton pump inhibitors were also associated with a slightly higher rate of CDI recurrence (13.0% vs. 8.4%). The rate of relapse fell significantly with increasing time since the index case of CDI by logistic regression (P = 0.011). In multivariate regression, relapse was associated with shorter time from index CDI, shorter durations of antibiotics, and the use of probiotics. Conclusion This retrospective study does not support the routine use of metronidazole in subsequent antibiotic courses following CDI. The use of probiotics paradoxically increased the rate of CDI relapse in this study. The limitations of this retrospective study do not eliminate the possibility of utility of vancomycin as prophylaxis, but this requires further evaluation. Disclosures All authors: No reported disclosures.

Oral Vancomycin as Secondary Prophylaxis for Clostridioides difficile Infection

PEDIATRICS ◽  
2021 ◽  
pp. e2020031807
Author(s):  
Hongkai Bao ◽  
Jennifer Lighter ◽  
Yanina Dubrovskaya ◽  
Cristian Merchan ◽  
Justin Siegfried ◽  
...  
Keyword(s):  
Secondary Prophylaxis ◽  
Oral Vancomycin ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection

scholarly journals Clostridioides (Clostridium) difficile Pacemaker Infection

2020 ◽  
Vol 7 (12) ◽  
Author(s):  
Anna Berkefeld ◽  
Fabian K Berger ◽  
Barbara C Gärtner ◽  
Nina Wantia ◽  
Anatol Prinzing ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Prosthetic Material ◽  
Oral Vancomycin ◽  
Molecular Subtyping ◽  
Documented Case ◽  
Clostridioides Difficile ◽  
Abdominal Symptoms ◽  
Intravascular Device ◽  
Nosocomial Diarrhea ◽  
Lead Infection

Abstract Clostridioides difficile is the leading cause of antibiotic-associated nosocomial diarrhea, but extra-intestinal manifestations are rare. We describe the first documented case of bacteraemia with pacemaker pocket and lead infection with the toxigenic C. difficile ribotype 014 with a lack of abdominal symptoms. The patient underwent pacemaker extraction and treatment with intravenous and oral vancomycin. Genotyping and molecular subtyping revealed clonality between pacemaker and intestinal isolates. This case illustrates the risk of intravascular device infections due to C. difficile. Even asymptomatic C. difficile colonization might pose a risk for prosthetic material infection.

scholarly journals Oral Vancomycin Is Highly Effective in Preventing Clostridium Difficile infection in Allogeneic Hematopoietic Stem Cell Transplant Recipients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2225-2225 ◽  
Author(s):  
Alex Ganetsky ◽  
Jennifer H Han ◽  
Mitchell E Hughes ◽  
Daria V. Babushok ◽  
Noelle V Frey ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Broad Spectrum ◽  
Research Funding ◽  
Antibiotic Use ◽  
Oral Vancomycin ◽  
Broad Spectrum Antibiotic ◽  
Myeloablative Conditioning ◽  
Hematopoietic Stem

Abstract Introduction: Infection remains a leading cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation (alloHCT). Among the most common infectious complications in alloHCT recipients is Clostridium difficile infection (CDI), a healthcare-associated, toxin-mediated diarrheal disease occurring in up to 30% of alloHCT recipients. We sought to evaluate whether prophylactic oral vancomycin reduces the incidence of CDI in alloHCT recipients. Methods: We conducted a retrospective cohort study to examine the effectiveness of CDI prophylaxis with oral vancomycin compared to no prophylaxis in 105 consecutive adults undergoing alloHCT at the University of Pennsylvania between April 2015 and July 2016. We initiated a pilot program of CDI prophylaxis with oral vancomycin for all alloHCT recipients starting in December 2015 (N=50). Patients received oral vancomycin 125 mg twice daily starting on the day of inpatient admission for alloHCT and continued until day of discharge. Prior to the initiation of this pilot, pharmacologic prophylaxis for CDI was not administered (control arm; N=55). Testing for C. difficile in patients with diarrhea was performed using an immunoassay for glutamate dehydrogenase and toxins A and B. Indeterminate results were confirmed by a molecular assay. Control and intervention patients were characterized by potential risk factors for CDI, including demographics, prior CDI, and recent broad-spectrum antibiotic use. Continuous variables were compared using the Wilcoxon rank-sum test, and categorical variables were compared using the χ2 or Fisher exact test. The primary outcome of interest was the incidence of CDI from inpatient admission for alloHCT to discharge. Results: The rate of recent broad-spectrum antibiotic use was significantly greater in the patients that received oral vancomycin prophylaxis compared to control patients (84.0% vs. 67.2; P=0.047). In addition, more patients in the vancomycin prophylaxis group received myeloablative conditioning (62.0% vs. 45.4%; P=0.09). There were no other significant differences in patient and transplant characteristics between the intervention and control groups, including mean age (54.3 vs. 56.4 years; P=0.6), myeloid malignancy (80.0% vs. 81.8%; P=0.8) and history of CDI in the prior year (22.0% vs. 9.0%; P=0.1). There were no cases of CDI in patients that received oral vancomycin prophylaxis (0/50; 0%) whereas 11/55 (20%) patients who did not receive vancomycin prophylaxis developed CDI during alloHCT (P=<0.001). The median (interquartile range) time to CDI diagnosis was 8 days (6 - 12). The median length of stay was non-significantly longer in the intervention patients (33.5 vs. 28.0 days; P=0.06), possibly due to the higher number of myeloablative conditioning transplants in the prophylactic vancomycin group. There were no cases of vancomycin-resistant enterococcus bloodstream infection in patients who received vancomycin prophylaxis. Conclusion: Prophylactic vancomycin is highly effective in preventing CDI in alloHCT recipients. Since CDI and/or its treatment may alter the gut microbiome, longer follow up will determine if there is any impact on other outcomes. Six month follow-up data for graft-versus-host disease and overall survival will be presented. Disclosures Frey: Novartis: Research Funding; Amgen: Consultancy; Servier: Consultancy. Gill:Novartis: Patents & Royalties, Research Funding. Hexner:Novartis: Research Funding; Blueprint medicines: Consultancy. Mangan:Incyte: Other: Advisory Board; Novartis: Research Funding. Porter:Novartis: Patents & Royalties, Research Funding; Genentech: Employment.

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