scholarly journals 1016. Standardized Antimicrobial Administration Ratio (SAAR) and Clostridioides difficile Infection Standardized Infection Ratio (SIR): Are they connected? An Evaluation of 28 Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S357-S357
Author(s):  
Danielle Sebastian ◽  
Florian Daragjati ◽  
Karl Saake ◽  
Lisa K Sturm ◽  
Mohamad G Fakih
Keyword(s):  
Antimicrobial Agent ◽  
Broad Spectrum ◽  
Antibacterial Agents ◽  
Control Strategies ◽  
Antibiotic Use ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated ◽  
Antimicrobial Administration

Abstract Background Clostridioides difficile infections (CDIs) are the most prevalent healthcare-associated infection in the U.S. Of all CDIs, most are related to healthcare exposures and are potentially preventable by reducing unnecessary antibiotic use and interrupting patient-to-patient transmission of CDI. Methods The adult SAARs for 4 antimicrobial agent categories were compared with the CDI SIR at 28 facilities with greater than 100 beds across the health system for the calendar year of 2018. The 4 adult antimicrobial agent categories chosen for comparison were: antibacterial agents posing the highest risk for CDI, broad-spectrum antibacterial agents predominantly used for hospital-onset infections (BSHO), broad-spectrum antibacterial agents predominantly used for community-acquired infections (BSCA) and all antibacterial agents. Results The 2018 aggregate CDI SIR for the 28 facilities was 0.609. The aggregate SAAR for the adult antimicrobial agent categories were 1.05 for the antibacterial agents posing the highest risk for CDI, 1.05 for BSHO, 0.88 for BSCA, and 1.03 for all antibacterial agents. No correlation was seen between any of the 4 adult SAAR antimicrobial agent categories and the facility CDI SIR (Figure 1–4). Conclusion While reducing unnecessary antibiotics is an important strategy in preventing CDIs, having a higher observed vs. predicted administration ratio in the four antimicrobial agent categories studied was not correlated with a higher CDI SIR, including the CDI SAAR category. Reduction of CDI is challenging requiring a multipronged approach to include infection control strategies, appropriate testing, and antimicrobial stewardship. Disclosures All authors: No reported disclosures.

scholarly journals Defining the black box: a narrative review of factors associated with adverse outcomes from severe Clostridioides difficile infection

2021 ◽  
Vol 14 ◽  
pp. 175628482110481
Author(s):  
Adam Ressler ◽  
Joyce Wang ◽  
Krishna Rao
Keyword(s):  
The United States ◽  
Adverse Outcomes ◽  
Chronic Illnesses ◽  
Narrative Review ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Patients At Risk ◽  
Hospital Deaths ◽  
Healthcare Associated

In the United States, Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infection, affecting nearly half a million people and resulting in more than 20,000 in-hospital deaths every year. It is therefore imperative to better characterize the intricate interplay between C. difficile microbial factors, host immunologic signatures, and clinical features that are associated with adverse outcomes of severe CDI. In this narrative review, we discuss the implications of C. difficile genetics and virulence factors in the molecular epidemiology of CDI, and the utility of early biomarkers in predicting the clinical trajectory of patients at risk of developing severe CDI. Furthermore, we identify associations between host immune factors and CDI outcomes in both animal models and human studies. Next, we highlight clinical factors including renal dysfunction, aging, blood biomarkers, level of care, and chronic illnesses that can affect severe CDI diagnosis and outcome. Finally, we present our perspectives on two specific treatments pertinent to patient outcomes: metronidazole administration and surgery. Together, this review explores the various venues of CDI research and highlights the importance of integrating microbial, host, and clinical data to help clinicians make optimal treatment decisions based on accurate prediction of disease progression.

scholarly journals Risk for Clostridioides difficile infection among hospitalized patients associated with multiple healthcare exposures prior to admission

2020 ◽  
Author(s):  
Aaron C Miller ◽  
Daniel K Sewell ◽  
Alberto M Segre ◽  
Sriram V Pemmaraju ◽  
Philip M Polgreen ◽  
...  
Keyword(s):  
Hospitalized Patients ◽  
Healthcare Associated Infection ◽  
Case Definitions ◽  
Multiple Exposures ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Increase Risk ◽  
Clostridioides Difficile Infection ◽  
Degree Of Association ◽  
Healthcare Associated

Abstract Purpose Clostridioides difficile infections (CDIs) are a common healthcare-associated infection and often used as indicators of hospital safety or quality. However, healthcare exposures occurring prior to hospitalization may increase risk for CDI. We conduct a case-control study comparing hospitalized patients with and without CDI to determine if healthcare exposures prior to hospitalization (i.e., clinic visits, antibiotics, family members with CDI) were associated with increased risk for hospital onset CDI, and how risk varied with time between exposure and hospitalization. Methods Records were collected from a large insurance-claims database from 2001-2017 for hospitalized adult patients. Prior healthcare exposures were identified using inpatient, outpatient, emergency department, and prescription drug claims; results were compared between various CDI case definitions. Results Hospitalized patients with CDI had significantly more frequent healthcare exposures prior to admission. Healthcare visits, antibiotics and family exposures were associated with greater likelihood of CDI during hospitalization. The degree of association diminished with time between exposure and hospitalization. Results were consistent across CDI case definitions. Conclusions Many different prior healthcare exposures appear to increase risk for CDI presenting during hospitalization. Moreover, patients with CDI typically have multiple exposures prior to admission, confounding the ability to attribute cases to a particular stay.

scholarly journals Broad-spectrum antibiotic use and poor outcomes in community-onset pneumonia: a cohort study

2019 ◽  
Vol 54 (1) ◽  
pp. 1900057 ◽  
Author(s):  
Brandon J. Webb ◽  
Jeff Sorensen ◽  
Al Jephson ◽  
Ian Mecham ◽  
Nathan C. Dean
Keyword(s):  
Cohort Study ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Average Treatment Effect ◽  
Broad Spectrum Antibiotic ◽  
Clostridioides Difficile ◽  
Broad Spectrum Antibiotics ◽  
Poor Outcomes ◽  
Healthcare Associated ◽  
Community Onset

QuestionIs broad-spectrum antibiotic use associated with poor outcomes in community-onset pneumonia after adjusting for confounders?MethodsWe performed a retrospective, observational cohort study of 1995 adults with pneumonia admitted from four US hospital emergency departments. We used multivariable regressions to investigate the effect of broad-spectrum antibiotics on 30-day mortality, length of stay, cost and Clostridioides difficile infection (CDI). To address indication bias, we developed a propensity score using multilevel (individual provider) generalised linear mixed models to perform inverse-probability of treatment weighting (IPTW) to estimate the average treatment effect in the treated. We also manually reviewed a sample of mortality cases for antibiotic-associated adverse events.Results39.7% of patients received broad-spectrum antibiotics, but drug-resistant pathogens were recovered in only 3%. Broad-spectrum antibiotics were associated with increased mortality in both the unweighted multivariable model (OR 3.8, 95% CI 2.5–5.9; p<0.001) and IPTW analysis (OR 4.6, 95% CI 2.9–7.5; p<0.001). Broad-spectrum antibiotic use by either analysis was also associated with longer hospital stay, greater cost and increased CDI. Healthcare-associated pneumonia was not associated with mortality independent of broad-spectrum antibiotic use. In manual review we identified antibiotic-associated events in 17.5% of mortality cases.ConclusionBroad-spectrum antibiotics appear to be associated with increased mortality and other poor outcomes in community-onset pneumonia.

scholarly journals 799. Mini Root Cause Analysis Reveals Opportunities for Reducing Clostridioides difficile Infection Rates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S443-S443
Author(s):  
Nicholas A Turner ◽  
Jessica L Seidelman ◽  
Rebekah Wrenn ◽  
Deverick J Anderson ◽  
Sarah S Lewis ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Broad Spectrum ◽  
Infection Type ◽  
Antibiotic Use ◽  
High Rate ◽  
Infection Rates ◽  
Root Cause ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Tract Infections

Abstract Background C. difficile remains the single most common pathogen among healthcare-associated infections. We conducted a multi-center, prospective study using on-site, near real-time root cause analyses to identify opportunities for reducing hospital-onset C. difficile infection rates (HO-CID). Methods This prospective cohort study enrolled inpatients with HO-CDI admitted to one of 20 participating hospitals in the southeastern United States from July 2019 to June 2020. For each HO-CDI case, mini root cause analyses were conducted by on-site physicians, infection preventionists, or stewardship pharmacists to assess appropriateness of C. difficile testing and inpatient antibiotic use from the 30 days preceding HO-CDI diagnosis. Results The cohort captured 554 total HO-CDI cases and 956 antibiotic use events. 147 (26.5%) of HO-CDI cases were adjudicated as likely inappropriate and a further 51 (9.2%) as potentially inappropriate. Among inappropriately tested cases, 103 (52.0%) had received either laxatives or tube feeds in the preceding 48 hours. 132 (13.8%) of antibiotic use events were identified as potentially inappropriate. Among potentially inappropriate antibiotic use events, 40 (30.3%) received unnecessarily broad-spectrum antibiotics, 20 (15.2%) lacked a confirmed infectious diagnosis, and 4 (3.0%) received a longer than guideline-recommended duration. Risk of inappropriate antibiotic use varied by infection type, with treatment of urinary tract infection being associated with the highest risk of inappropriate antibiotic use (table 1). Table 1: Relative Risk of Inappropriate Antibiotic Use by Indication Conclusion Mini root cause analyses may be a helpful tool for identifying -specific opportunities to reduce HO-CDI rates. We found a high rate of inappropriate testing, usually related to alternative causes for diarrhea such as laxative receipt or tube feeds. While rates of inappropriate antibiotic use were lower than has been reported elsewhere, the majority of opportunities for improvement related to overly broad-spectrum coverage. Urinary tract infections were most strongly associated with inappropriate antibiotic use preceding HO-CDI. Disclosures All Authors: No reported disclosures

scholarly journals Recent advances in the treatment of Clostridioides difficile infection: the ever-changing guidelines

2020 ◽  
Vol 9 ◽  
Author(s):  
Shruti Khurana ◽  
Alyssa Kahl ◽  
Kevin Yu ◽  
Andrew W DuPont
Keyword(s):  
Infectious Diseases ◽  
Diagnostic Testing ◽  
Antibody Therapy ◽  
Treatment Strategies ◽  
Current Evidence ◽  
Healthcare Associated Infection ◽  
The Past ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated

Clostridioides difficile infection (CDI), formerly known as Clostridium difficile, continues to be the most common healthcare-associated infection worldwide. With the shifting epidemiology towards higher a incidence of community-acquired CDI and the continued burden on the healthcare system posed by high rates of CDI recurrence, there has been an impetus to advance the diagnostic testing and treatment strategies. Recent advancements over the past decade have led to rapidly changing guidelines issued by the Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases. With our comprehensive review, we aim to summarize the latest advances in diagnosing and treating CDI and thus attempt to help readers guide best practices for patient care. This article also focusses on cost-effectiveness of various therapies currently available on the market and provides an analysis of the current evidence on a relatively new monoclonal antibody therapy, Bezlotoxumab, to treat recurrent CDI.

scholarly journals 803. Risk factors associated with Clostridioides difficile infection in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S445-S445
Author(s):  
William Justin Moore ◽  
Caroline C Jozefczyk ◽  
Paul R Yarnold ◽  
Karolina Harkabuz ◽  
Valerie Widmaier ◽  
...  
Keyword(s):  
Risk Factors ◽  
Decomposition Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Structural Decomposition Analysis ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Pre Treatment ◽  
Healthcare Associated

Abstract Background Patients with community-acquired pneumonia (CAP) who are hospitalized and treated with antibiotics may carry an increased risk for developing Clostridioides difficile infection (CDI). Accurate risk estimation tools are needed to guide monitoring and CDI mitigation efforts. We aimed to identify patient-specific risk factors associated with CDI among hospitalized patients with CAP. Methods Design: retrospective case-control study of hospitalized patients who received CAP-directed antibiotic therapy between 1/1/2014 and 5/29/2018. Cases were hospitalized CAP patients who developed CDI post-admission. Control patients did not develop CDI and were selected at random from CAP patients hospitalized during this period. Variables: comorbidities, laboratory results, vital signs, severity of illness, prior hospitalization, and past antibiotic use. Propensity-score weights: identified via structural decomposition analysis of pre-treatment variables. Analysis: weighted classification tree models that predicted any CDI, hospital-onset CDI, and any healthcare-associated CDI according to CAP antibiotic treatment. Performance: percent accuracy in classification (PAC) and weighted positive (PPV) and negative predictive values (NPV). Modeling: completed using the ODA package (v1.0.1.3) for R (v3.5.1). Results A total of 32 cases and 232 controls were identified. Sixty pre-treatment variables were screened. Structural decomposition analysis, completed in two stages, identified prior hospitalization (OR 6.56, 95% CI: 3.01-14.31; PAC: 80.3%) and BUN greater than 29 mg/dL (OR 11.67, 95% CI: 2.41-56.5; PAC: 80.8%) as propensity-score weights. With respect to CDI, receipt of broad-spectrum anti-pseudomonal antibiotics was significantly (all P’s&lt; 0.05) associated with any CDI (NPV: 90.29%, PPV: 27.94%), hospital-onset CDI (NPV: 97.53%, PPV: 26.86%), and healthcare-associated CDI (NPV: 92.89%, PPV: 27.94%). Conclusion We identified risk factors available at hospital admission and empiric use of broad-spectrum Gram-negative antibiotics as being associated with the development of CDI. Model PPVs were over two-fold greater than our sample base rate. Increased monitoring and avoidance of overly broad antibiotic use in high-risk patients appears warranted. Disclosures All Authors: No reported disclosures

scholarly journals Clostridium difficile Infection: An Epidemiology Update

2020 ◽  
Vol 33 (02) ◽  
pp. 049-057 ◽  
Author(s):  
Ana C. De Roo ◽  
Scott E. Regenbogen
Keyword(s):  
Risk Factors ◽  
Antibiotic Use ◽  
Recurrence Risk ◽  
Epidemiologic Studies ◽  
High Morbidity ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Hospitalized Older Adults ◽  
Healthcare Associated

Abstract Clostridium (reclassified as “Clostridioides”) difficile infection (CDI) is a healthcare-associated infection and significant source of potentially preventable morbidity, recurrence, and death, particularly among hospitalized older adults. Additional risk factors include antibiotic use and severe underlying illness. The increasing prevalence of community-associated CDI is gaining recognition as a novel source of morbidity in previously healthy patients. Even after recovery from initial infection, patients remain at risk for recurrence or reinfection with a new strain. Some pharmaco-epidemiologic studies have suggested an increased risk associated with proton pump inhibitors and protective effect from statins, but these findings have not been uniformly reproduced in all studies. Certain ribotypes of C. difficile, including the BI/NAP1/027, 106, and 018, are associated with increased antibiotic resistance and potential for higher morbidity and mortality. CDI remains a high-morbidity healthcare-associated infection, and better understanding of ribotypes and medication risk factors could help to target treatment, particularly for patients with high recurrence risk.

scholarly journals Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Eliza Manea ◽  
Raluca Jipa ◽  
Alexandru Milea ◽  
Antonia Roman ◽  
Georgiana Neagu ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Group Versus ◽  
Antibiotic Use ◽  
Similar Rate ◽  
Antimicrobial Treatment ◽  
Care Hospital ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated

Abstract Introduction Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic. Methods We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018. Results We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days). Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment – mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group. Conclusions The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19. What is important: Information on healthcare-acquired C.difficile in COVID-19 patients is limited, but not only C.difficile infection remains a worrying issue, but is also an emerging topic. We found that antibiotic use seems to be the most important factor associated with CDI and our data emphasize the need for rational use of antibiotics and for ongoing attention regarding CDI in COVID-19 patients.

#37: Clinical Characterization of the Cases Relating to the Outbreak of Clostridioides difficile, in a Third-level Hospital in Mexico City: Diagnosis, Treatment, and Relay

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S16-S16
Author(s):  
Ortiz Samuel ◽  
Martínez María Elena ◽  
Morayta Ramírez A
Keyword(s):  
Antibiotic Use ◽  
Clinical Findings ◽  
Prevention Measures ◽  
Clostridioides Difficile ◽  
Young Infants ◽  
Plastic Bags ◽  
History Of ◽  
Initial Episode ◽  
Group Sex ◽  
Healthcare Associated

Abstract Background Clostridioides difficile is an important cause of healthcare-associated infections. The epidemiology of C. difficile infection (CDI) in children has changed over the past few decades. There is now a higher incidence in hospitalized children, and there has been an emergence of community-onset infection. Neonates and young infants have high rates of colonization but rarely have symptoms. The well-known risk factor for CDI in children age 2 years or older is antibiotic use. Inflammatory bowel disease and cancer are associated with increased incidence and severity of CDI. Vancomycin or fidaxomicin is recommended for an initial episode of CDI. In environments where access to Vancomycin or Fidaxomycin is limited, it is suggested to use metronidazole for an initial episode of nonsevere CDI only. Methods A series of cases were carried out, in a study period from March to May 2018, total cases 8; the age group, sex, basic diagnosis, clinical findings, diagnostic method, and outcome in hospitalized patients in the Pediatric division of the “CMN 20 de Noviembre, ISSSTE” were described, where there is a total of 377 Sensitive beds, and 53 beds in the pediatric area of which 30 are not sensitive. Results We analyzed 8 cases of diarrhea with identification of C. difficile, in a period of 3 months, where there was a total of 148 admissions to the division of Pediatrics (100%) and presented a prevalence of 0.05% of the total income. Of those 8 cases reported, 37.5% were women and 62.5% men; The age fluctuated between 6 months and 18 years. All children had associated comorbidities. The frequency and type of comorbidities were Cancer 87.5% (Leukemias and Solid Tumors) and Neurological 12.5% ​​(Arterial Malformation and Neurological Sequelae). The main symptom that occurred was mucous diarrhea in 100% of patients, abdominal pain in 25% and evacuation with blood in 12.5% ​​of cases. All had a history of prior treatment with 100% broad-spectrum antibiotics, in a period of less than one month. All were treated with metronidazole (100%) and all presented clinical improvement, without complications; Similarly, all were diagnosed by PCR for toxin B (100%). The attributable risk of presenting Clostridioides disease in patients with Leukemia is 0.11. Conclusions Patients with Leukemia were the most affected during the C. difficile outbreak, of which 11 out of 100 of these patients are at risk of presenting C. difficile disease. The most important thing in these cases is prevention. Therefore, specific prevention measures were implemented to reduce the possibility of future outbreaks, such as handwashing with chlorexidine, contact isolation, handwashing every time there is contact with the patient, use of gloves when performing procedures, insulation of bedding in plastic bags and training of health personnel.

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