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

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.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.003 ◽

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.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1421 ◽

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

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The evaluation of Clostridium difficile infection (CDI) in a community hospital

Journal of Infection and Public Health ◽

10.1016/j.jiph.2014.08.002 ◽

2015 ◽

Vol 8 (2) ◽

pp. 155-160 ◽

Cited By ~ 7

Author(s):

Aju Daniel ◽

Alwyn Rapose

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Community Hospital

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

Journal of Pharmacy Practice ◽

10.1177/0897190007302892 ◽

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.

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