scholarly journals Impact of Delayed Oral Vancomycin for Severe Clostridium difficile Infection

2018 ◽  
Vol 54 (5) ◽  
pp. 294-299 ◽  
Author(s):  
Sunish Shah ◽  
Benjamin Ereshefsky ◽  
Laura Pontiggia ◽  
Michael Cawley
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Initial Treatment ◽  
Oral Vancomycin ◽  
End Of Treatment ◽  
Significant Difference ◽  
Severe Clostridium Difficile Infection ◽  
The Impact

Background: Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (VAN) is known to be superior to treatment with metronidazole (MDZ). However, previous studies have not evaluated the impact on patients when oral VAN therapy is delayed after diagnosis of severe CDI. Materials and Methods: This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI. The objective was to compare clinical outcomes for patients treated initially with oral VAN versus patients receiving delayed oral VAN after at least 48 hours of initial treatment with MDZ. The primary outcome was all-cause in-hospital mortality. Results: There were 101 patients who comprised the initial oral VAN group, while 20 patients comprised the delayed oral VAN group. There was no significant difference in all-cause in-hospital mortality for patients in the initial oral VAN treatment group compared to those who had delayed oral VAN therapy (4.95% vs 15.00%, P = 0.13). Patients who were initially treated with oral VAN experienced a significantly higher rate of clinical cure (49.50% vs 20.00%, P = 0.02), shorter median postinfection length of hospitalization (7.0 days vs 13.0 days, P < 0.001), shorter median time to resolution of leukocytosis (3.9 days vs 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs 29.4%, P = 0.03). Conclusion: Patients who receive oral VAN as their initial treatment for severe CDI experience improved clinical outcomes compared to patients receiving delayed oral VAN after being initially treated with MDZ.

scholarly journals Initial Oral Vancomycin vs. Oral Vancomycin After Metronidazole for Severe Clostridium difficile Infection

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S390-S390
Author(s):  
Sunish Shah ◽  
Benjamin Ereshefsky ◽  
Laura Pontiggia ◽  
Michael Cawley
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Clostridium Difficile Infection ◽  
Post Infection ◽  
Clinical Cure ◽  
Oral Vancomycin ◽  
End Of Treatment ◽  
Severe Clostridium Difficile Infection ◽  
The Impact ◽  
Length Of Hospitalization

Abstract Background Treatment of severe Clostridium difficile infection (CDI) with oral vancomycin (oVAN) is known to be superior to treatment with metronidazole. However, previous studies have not evaluated the impact on patients when oVAN therapy is delayed after diagnosis or suspicion of severe CDI. Methods This was a single-center, retrospective study of adult patients who were diagnosed with severe CDI as defined by a white blood cell (WBC) count greater than 15,000 cells/mm3. The primary outcome was in-hospital mortality between patients treated initially with oVAN vs. delayed oVAN after metronidazole. Secondary outcomes included clinical cure by day 10, post-infection length of hospitalization, the time to resolution of leukocytosis and renal function at the end of treatment. Leukocytosis was defined as a WBC greater than 12,000 cells/mm3. Patients were excluded if they received oVAN for a previous episode of CDI, were receiving treatment for a concurrent infection, were receiving high-dose steroids, or received metronidazole or oVAN within 5 days preceding CDI diagnosis. Results A total of 121 patients were included. Overall, 49% of patients were female and the median age was 67 years old. 101 patients comprised the initial oVAN group, while 20 patients comprised the delayed oVAN group. Baseline demographics did not differ significantly between groups other than the time to initiation of oVAN (0.33 vs. 3.18 days, P &lt; 0.001). There was no significant difference in in-hospital mortality for patients in the initial oVAN treatment group compared with those who had delayed oVAN therapy (5% vs. 15%, P = 0.13). Patients who received oVAN initially experienced a higher rate of clinical cure by day 10 (49.5% vs. 20%, P = 0.02), a shorter median post-infection length of hospitalization (7 days vs. 13 days, P &lt; 0.001), a shorter median time to resolution of leukocytosis (3.9 days vs. 10.4 days, P = 0.01), and were less likely to have an end of treatment serum creatinine greater than 1.5 times their baseline (8.7% vs. 29.4%, P = 0.03). Conclusion Patients who receive oVAN as their initial treatment for severe CDI have improved clinical outcomes compared with those initially treated with metronidazole. Disclosures All authors: No reported disclosures.

scholarly journals Oral teicoplanin for successful treatment of severe refractory Clostridium difficile infection

2015 ◽  
Vol 9 (10) ◽  
pp. 1062-1067 ◽  
Author(s):  
Natasa Popovic ◽  
Milos Korac ◽  
Zorica Nesic ◽  
Branko Milosevic ◽  
Aleksandar Urosevic ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Combination Therapy ◽  
Clostridium Difficile Infection ◽  
Clinical Cure ◽  
Oral Vancomycin ◽  
Clinical Center ◽  
Significant Difference ◽  
Cure Time ◽  
Severe Clostridium Difficile Infection ◽  
One Year

Introduction: Clostridium difficile is the leading cause of hospital-acquired diarrhoea. There is no defined protocol for treating severe Clostridium difficile infection (CDI) refractory to vancomycin or vancomycin and metronidazole combination therapy. The aim of this study was to evaluate the rate of clinical cure, time to resolution of diarrhoea and recurrence rate in patients with severe refractory CDI treated with oral teicoplanin. Methodology: A one-year prospective study was carried out in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia. Patients with severe and complicated CDI who failed to respond to oral vancomycin and intravenous metronidazole combination therapy were enrolled. They were given oral teicoplanin 100 mg bi-daily. Patients were followed for recurrence for eight weeks. Results: Nine patients with a mean age of 70.8±9.4 years were analyzed. All patients had pseudomembranous colitis, and five had complicated disease. In four patients intracolonic delivery of vancomycin was also performed in addition to oral vancomycin and intravenous metronidazole prior to initiating teicoplanin, but without improvement. After teicoplanin initiation all patients achieved clinical cure. The mean time to resolution of diarrhoea after teicoplanin introduction was 6.3±4.5 days. There was no statistically significant difference in time to resolution of diarrhoea according to initial leucocyte count, age over 65 years, the presence of ileus, complicated disease and the use of concomitant antibiotic therapy (p = 0.652, 0,652, 0.374, 0.374, and 0,548, respectively). None of the patients experienced recurrence. Conclusions: Oral teicoplanin might be a potential treatment for severe and complicated refractory CDI, but further studies are required.

scholarly journals Intravenous Tigecycline Facilitates Cure of Severe Clostridium difficile Infection (CDI) After Failure of Standard Therapy: A Case Report and Literature Review of Tigecycline Use in CDI

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Bhagyashri D. Navalkele ◽  
Stephen A. Lerner
Keyword(s):  
Septic Shock ◽  
Case Report ◽  
Clostridium Difficile ◽  
Literature Review ◽  
Clostridium Difficile Infection ◽  
Standard Treatment ◽  
Fecal Transplant ◽  
Oral Vancomycin ◽  
Standard Regimen ◽  
Severe Clostridium Difficile Infection

Abstract Standard treatment for severe Clostridium difficile infection (CDI) is oral vancomycin with metronidazole. After failure of this standard regimen, treatment becomes challenging. A young woman treated for septic shock developed CDI. Standard treatment failed and she was ineligible for fecal transplant. Addition of tigecycline to her regimen resulted in cure.

Abstract 17173: Association of Acute Gout Flares and Colchicine Use With Clinical Outcomes During Admission for Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Melissa E Chinn ◽  
Mary E Roth ◽  
Steven P Dunn ◽  
Kenneth C Bilchick ◽  
Sula Mazimba
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Readmission Rate ◽  
Acute Gout ◽  
Significant Difference ◽  
The Impact ◽  
Gout Flare

Introduction: Gout is a common comorbidity in heart failure (HF) patients, and is often exacerbated by diuretic use. The impact of gout or the treatment of gout on HF outcomes is unknown. The purpose of this study was to assess clinical outcomes in patients being treated for an acute HF exacerbation and receiving colchicine for an acute gout flare. Methods: This was a single center, retrospective cohort study of patients treated for an acute HF exacerbation from March 2011 to February 2020. The gout group included patients receiving colchicine for an acute gout flare during admission. The control group included those who did not receive colchicine for an acute gout flare. The primary outcome was 30-day readmission rate. Secondary outcomes included in-hospital mortality and length of stay. Results: In the cohort of 1,047 patients (68.8 +/- 13.7 years, 38% female), 237 patients received colchicine for acute gout during admission. Length of stay was significantly greater (9.93 days vs. 7.96 days, p < 0.0001) and in-hospital mortality was significantly lower (2.2% vs. 6.6%, p = 0.009) in patients with versus without gout. In a multivariate logistic regression model, in-hospital colchicine given for a gout flare was significantly associated with reduced in-hospital mortality (OR 0.322, 95% CI 0.105-0.779, p = 0.02) after adjustment for home beta blocker use, inotrope use, age, and diabetes mellitus (p < 0.05 for all in the model). The association between colchicine and survival to hospital discharge was only observed in patients who received colchicine during the hospitalization, as opposed to home use only. There was no significant difference in 30-day readmission rate based on gout status for patients surviving to hospital discharge (21.5% vs. 19.5%, p = 0.495). Conclusions: Among patients with an acute HF exacerbation, patients treated for an acute gout flare with colchicine had a greater length of stay and lower in-hospital mortality compared with those not having gout. Future analyses are warranted to identify the relationship between colchicine use and HF outcomes.

Empirical Antimicrobial Prescriptions in Patients with Clostridium difficile Infection at Hospital Admission and Impact on Clinical Outcome

2012 ◽  
Vol 33 (11) ◽  
pp. 1101-1106 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Eman Shaban ◽  
Cecile Letourneau ◽  
Angel Pechie
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Clinical Outcomes ◽  
Prolonged Exposure ◽  
Adverse Outcomes ◽  
Concurrent Use ◽  
Independent Risk Factors ◽  
The Impact

Objective.To determine, among patients with Clostridium difficile infection (CDI) at hospital admission, the impact of concurrent use of systemic, non-CDI-related antimicrobials on clinical outcomes and the risk factors associated with unnecessary antimicrobial prescribing.Design.Retrospective cohort study.Setting.University-affiliated community hospital.Methods.We reviewed computerized medical records for all patients with CDI at hospital admission during a 24-month period (January 1, 2008, through December 31, 2009). Colectomy, discharge to hospice, and in-hospital mortality were considered to be adverse outcomes. Antimicrobial use was considered unnecessary in the absence of physical signs and laboratory or radiological findings suggestive of an infection other than CDI or in the absence of antimicrobial activity against the organism(s) recovered from clinical cultures.Results.Among the 94 patients with CDI at hospital admission, 62% received at least one non-CDI-related antimicrobial during their hospitalization for CDI. Severe complicated CDI (odds ratio [OR], 7.1 [95% confidence interval {CI}, 1.8–28.5]; P = .005), duration of non-CDI-related antimicrobial exposure (OR, 1.2 [95% CI, 1.03–1.36]; P = .016), and age (OR, 1.1 [95% CI, 1.0–1.1]; P = .043) were independent risk factors for adverse clinical outcomes. One-third of the patients received unnecessary antimicrobial therapy. Sepsis at hospital admission (OR, 5.3 [95% CI, 1.8–15.8]; P = .003) and clinical suspicion of urinary tract infection (OR, 9.7 [95% CI, 2.9–32.3]; P< .001) were independently associated with unnecessary antimicrobial prescriptions.Conclusions.Empirical use of non-CDI-related antimicrobials was common. Prolonged exposure to non-CDI-related antimicrobials was associated with adverse clinical outcomes, including increased in-hospital mortality. Minimizing non-CDI-related antimicrobial exposure in patients with CDI seems warranted.

Incidence and outcomes of hospitalized patients with gastrointestinal malignancies and Clostridium difficile infection: A nationwide analysis.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 704-704
Author(s):  
Arjun Gupta ◽  
Raseen Tariq ◽  
Nivedita Arora ◽  
Ryan D. Frank ◽  
Muhammad S. Beg ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Cancer Patients ◽  
Clostridium Difficile Infection ◽  
Care Facility ◽  
Hospitalized Patients ◽  
National Database ◽  
Gastrointestinal Malignancies ◽  
Gi Cancer ◽  
The Impact

704 Background: Inpatients with gastrointestinal (GI) malignancies are at a high risk for Clostridium difficile infection (CDI) but the impact of CDI on outcomes in these patients needs elucidation. We analyzed the incidence of CDI and its impact on outcomes in GI cancer patients using the National Hospital Discharge Survey (NHDS) database from 2001 - 2010. Methods: NHDS collects clinical information on patients dismissed from non-Federal short-stay United States hospitals. Demographics, diagnoses (GI malignancies, CDI and comorbidities), length of stay (LOS), and dismissal information were abstracted using ICD-9 diagnosis and procedure codes. Weighted analyses were performed using SAS version 9.4. Results: Of an estimated 317.9 million unique hospitalizations; 4.6 million had a diagnosis of a GI malignancy (1.4%); median age 68 years, 46.1% female. CDI was more common in patients with GI malignancies compared to patients with no GI malignancy (1.05% vs 0.69%, aOR 1.16, 95% CI 1.15- 1.17, p < 0.0001). There was a significant increase in CDI incidence in GI cancer patients over the 10-year study period (72.7 in 2001-2002 to 109.1 in 2009-2010, per 10,000 discharges, p < 0001). In multivariable analysis, compared to GI cancer patients without CDI, GI cancer patients with CDI had a longer mean LOS (3.94 more days, 95% CI 3.31-4.56) and dismissal to a care facility (adjusted OR, 1.75; 95% CI, 1.71-1.79), but lower all-cause in-hospital mortality (adjusted OR, 0.76; 95% CI, 0.74-0.79), all p < 0.0001 Conclusions: In this national database of hospitalized patients, an increasing incidence of CDI in patients with GI malignancies was noted over the study period. CDI prolonged hospitalization, and was associated with increased dismissal to a care-facility. Lower rates of in-hospital mortality may represent early diagnosis due to vigilance or a milder form of CDI. Despite increased attention over the last few decades, CDI remained a serious infection in GI cancer patients, and merits appropriate prevention, management and follow-up.

scholarly journals Prevalence and Clinical Outcomes of Clostridium difficile Infection in the Intensive Care Unit: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Styliani Karanika ◽  
Suresh Paudel ◽  
Fainareti N. Zervou ◽  
Christos Grigoras ◽  
Ioannis M. Zacharioudakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Clostridium Difficile ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Clostridium Difficile Infection ◽  
Meta Analysis ◽  
Icu Patients ◽  
Significant Difference

Abstract Background.  Intensive care unit (ICU) patients are at higher risk for Clostridium difficile infection (CDI). Methods. We performed a systematic review and meta-analysis of published studies from 1983 to 2015 using the PubMed, EMBASE, and Google Scholar databases to study the prevalence and outcomes of CDI in this patient population. Among the 9146 articles retrieved from the studies, 22 articles, which included a total of 80 835 ICU patients, were included in our final analysis. Results.  The prevalence of CDI among ICU patients was 2% (95% confidence interval [CI], 1%–2%), and among diarrheic ICU patients the prevalence was 11% (95% CI, 6%–17%). Among CDI patients, 25% (95% CI, 5%–51%) were diagnosed with pseudomembranous colitis, and the estimated length of ICU stay before CDI acquisition was 10.74 days (95% CI, 5%–51%). The overall hospital mortality among ICU patients with CDI was 32% (95% CI, 26%–39%), compared with 24% (95% CI, 14%–36%) among those without CDI presenting a statistically significant difference in mortality risk (P = .030). It is worth noting that the length of ICU and hospital stay among CDI patients was significantly longer, compared with non-CDI patients (standardized mean of difference [SMD] = 0.49, 95% CI, .39%–.6%, P = .00 and SMD = 1.15, 95% CI, .44%–1.91%, P = .003, respectively). It is noteworthy that the morbidity score at ICU admission (Acute Physiology and Chronic Health Evaluation II [APACHE II]) was not statistically different between the 2 groups (P = .911), implying that the differences in outcomes can be attributed to CDI. Conclusions.  The ICU setting is associated with higher prevalence of CDI. In this setting, CDI is associated with increased hospital mortality and prolonged ICU and overall hospital stay. These findings highlight the need for additional prevention and treatment studies in this setting.

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