scholarly journals Characteristics of patients infected with Clostridioides difficile at a Saudi Tertiary Academic Medical Center and assessment of antibiotic duration

Gut Pathogens ◽  
2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Khadijah M. Alammari ◽  
Abrar K. Thabit
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Acid Suppression ◽  
Prior Exposure ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Acid Suppression Therapy ◽  
Medical Wards ◽  
Hospital Acquired

Abstract Background Clostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, this study aimed to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI. Methods This was a retrospective descriptive analysis of CDI patients at a Saudi tertiary academic medical center between December 2007 and January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed. Results A total of 159 patients were included. Median age was 62 years. Most cases were hospital-acquired (71.1%), non-severe (44.7%), and admitted to medical wards (81.1%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (76.1 and 75.5%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 14 days for the β-lactams and 26 days for ciprofloxacin. The distribution of DOT was significantly different for piperacillin/tazobactam in different units (P = 0.003) where its median DOT was the shortest in medical wards (11 days), and for ciprofloxacin among different severity groups (P = 0.013), where its median DOT was the shortest in severe CDI patients (11 days). Conclusion Most patients in this study had hospital-acquired non-severe CDI and were largely exposed to antibiotics and acid suppression therapy. Therefore, such therapies should be revised for necessity.

scholarly journals Characteristics of Patients Infected With Clostridioides Difficile at a Saudi Tertiary Academic Medical Center and Assessment of Antibiotic Duration

2020 ◽  
Author(s):  
Khadijah M. Alammari ◽  
Abrar K. Thabit
Keyword(s):  
Medical Center ◽  
Descriptive Analysis ◽  
Academic Medical Center ◽  
Prior Exposure ◽  
Antibiotic Exposure ◽  
Clostridioides Difficile ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Acid Suppression Therapy ◽  
Hospital Acquired

Abstract BackgroundClostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI development. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, the objective of this study was to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI.MethodsThis was a retrospective descriptive analysis of CDI patients identified via laboratory testing at a Saudi tertiary academic medical center between December 2007-January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed.ResultsA total of 162 patients were included. Median age was 61.5 years. Most cases were hospital-acquired (70.4%) and admitted to general medical wards (81.5%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (75.9 and 75.3%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 16.5, 16, 16, and 28 days, respectively. The distribution of DOT was significantly different for piperacillin/tazobactam, ceftriaxone, and ciprofloxacin in different units (P < 0.05). Counterintuitively, patients in non-ICU wards had the shortest antibiotic exposure prior to CDI development.ConclusionAs CDI is a common hospital-acquired infection resulting mainly from antibiotic exposure, results from this study indicate the need to revise antibiotic therapy to assess necessity and discontinue it when deemed unnecessary within the first two weeks.

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals Epidemiology of Hospital-Acquired Urinary Tract–Related Bloodstream Infection at a University Hospital

2011 ◽  
Vol 32 (11) ◽  
pp. 1127-1129 ◽  
Author(s):  
Robert Chang ◽  
M. Todd Greene ◽  
Carol E. Chenoweth ◽  
Latoya Kuhn ◽  
Emily Shuman ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Bloodstream Infection ◽  
Case Fatality Rate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Case Fatality ◽  
University Hospital ◽  
Academic Medical ◽  
Hospital Acquired

Little is known about the epidemiology of nosocomial urinary tract-related bloodstream infection. In a case series from an academic medical center, Enterococcus (28.7%) and Candida (19.6%) species were the predominant microorganisms, which suggests a potential shift from gram-negative microorganisms. A case-fatality rate of 32.8% highlights the severity of this condition.

scholarly journals Improvement of gram-negative susceptibility to fluoroquinolones after implementation of a pre-authorization policy for fluoroquinolone use: A decade-long experience

2018 ◽  
Vol 39 (12) ◽  
pp. 1419-1424 ◽  
Author(s):  
Rachael A. Lee ◽  
Morgan C. Scully ◽  
Bernard C. Camins ◽  
Russell L. Griffin ◽  
Danielle F. Kunz ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rate Of Change ◽  
Gram Negative ◽  
E Coli ◽  
Stewardship Program ◽  
Restriction Policy ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Gram Negative Organisms

AbstractObjectiveDue to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance.DesignRetrospective cohort.SettingLarge academic medical center.MethodsWe performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp., Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Primary endpoint was the change of FQ susceptibility. A Poisson regression model was used to calculate the rate of change between the preintervention period (1998–2005) and the postimplementation period (2006–2016).ResultsLarge rates of decline of FQ susceptibility began in 1998, particularly among P. aeruginosa, Acinetobacter spp., and E. cloacae. Our FQ restriction policy improved FQ use from 173 days of therapy (DOT) per 1,000 patient days to <60 DOT per 1,000 patient days. Fluoroquinolone susceptibility increased for Acinetobacter spp. (rate ratio [RR], 1.038; 95% confidence interval [CI], 1.005–1.072), E. cloacae (RR, 1.028; 95% CI, 1.013–1.044), and P. aeruginosa (RR, 1.013; 95% CI, 1.006–1.020). No significant change in susceptibility was detected for K. pneumoniae (RR, 1.002; 95% CI, 0.996–1.008), and the susceptibility for E. coli continued to decline, although the decline was not as steep (RR, 0.981; 95% CI, 0.975–0.987).ConclusionsA stewardship-driven FQ restriction program stopped overall declining FQ susceptibility rates for all species except E. coli. For 3 species (ie, Acinetobacter spp, E. cloacae, and P. aeruginosa), susceptibility rates improved after implementation, and this improvement has been sustained over a 10-year period.

Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile

2019 ◽  
Vol 40 (6) ◽  
pp. 710-712 ◽  
Author(s):  
Michele S. Fleming ◽  
Olivia Hess ◽  
Heather L. Albert ◽  
Emily Styslinger ◽  
Michelle Doll ◽  
...  
Keyword(s):  
Decision Support ◽  
Medical Record ◽  
Critical Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clostridioides Difficile ◽  
Testing Frequency ◽  
Academic Medical ◽  
Support Matrix ◽  
The Impact

AbstractWe assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.

The Safety of Midline Catheters for Intravenous Therapy at a Large Academic Medical Center

2019 ◽  
Vol 54 (3) ◽  
pp. 232-238 ◽  
Author(s):  
Hangil Seo ◽  
Diana Altshuler ◽  
Yanina Dubrovskaya ◽  
Mark E. Nunnally ◽  
Catherine Nunn ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Intravenous Therapy ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Medication Therapy ◽  
Academic Medical ◽  
Outpatient Group ◽  
Days Of Therapy

Background: Midline catheters (MCs) have arisen as alternatives to peripherally inserted central catheters (PICCs) for both general intravenous therapy and extended outpatient parenteral therapy. However, there is a lack of data concerning the safety of medication therapy through midline for extended durations. Objective: The purpose of this study is to evaluate the safety of MCs for extended intravenous use. Methods: This was a retrospective cohort study evaluating patients who received intravenous therapy through an MC at a tertiary care academic medical center. The primary end point was the incidence of composite catheter-related adverse events that included local events, catheter dislodgment, infiltration, catheter occlusion, catheter-related venous thromboembolism, extravasation, and line-associated infection. Results: A total of 82 MC placements and 50 PICC placements were included; 50 MCs were for outpatient parenteral antimicrobial therapy, and 32 were for inpatient intravenous use. There were 21 complications per 1000 catheter-days in the outpatient group and 7 complications per 1000 catheter-days in the PICC group ( P = 0.91). The median time to complication in both groups was 8 days. The antimicrobial classes commonly associated with complications were cephalosporins, carbapenems, and penicillins. Conclusion and Relevance: Our results suggest that intravenous therapy with MCs is generally safe for prolonged courses that do not exceed 14 days as compared with PICC lines, which can be placed for months. There is still limited evidence for the use of MCs between 14 and 28 days of therapy. This study can help guide our selection of intravenous catheters for the purpose of outpatient antimicrobial therapy.

The Impact of Discontinuing Contact Precautions for VRE and MRSA on Device-Associated Infections

2015 ◽  
Vol 36 (8) ◽  
pp. 978-980 ◽  
Author(s):  
Michael B. Edmond ◽  
Nadia Masroor ◽  
Michael P. Stevens ◽  
Janis Ober ◽  
Gonzalo Bearman
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Infection Rates ◽  
Hospital Acquired Infection ◽  
Contact Precautions ◽  
Academic Medical ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact ◽  
Before And After Study

The impact of discontinuing contact precautions for patients with MRSA and VRE colonization/infection on device-associated hospital-acquired infection rates at an academic medical center was investigated in this before-and-after study. In the setting of a strong horizontal infection prevention platform, discontinuation of contact precautions had no impact on device-associated hospital-acquired infection rates.Infect. Control Hosp. Epidemiol. 2015;36(8):978–980

scholarly journals Screening of Clostridioides difficile carriers in an urban academic medical center: Understanding implications of disease

2019 ◽  
pp. 1-5
Author(s):  
Sarah W. Baron ◽  
Belinda E. Ostrowsky ◽  
Priya Nori ◽  
David Y. Drory ◽  
Michael H. Levi ◽  
...  
Keyword(s):  
Proportional Hazards Model ◽  
Screening Program ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Significant Risk ◽  
Cox Proportional Hazards Model ◽  
Nursing Facility ◽  
Clostridioides Difficile ◽  
Academic Medical

Abstract Objective: Efforts to reduce Clostridioides difficile infection (CDI) have targeted transmission from patients with symptomatic C. difficile. However, many patients with the C. difficile organism are carriers without symptoms who may serve as reservoirs for spread of infection and may be at risk for progression to symptomatic C. difficile. To estimate the prevalence of C. difficile carriage and determine the risk and speed of progression to symptomatic C. difficile among carriers, we established a pilot screening program in a large urban hospital. Design: Prospective cohort study. Setting: An 800-bed, tertiary-care, academic medical center in the Bronx, New York. Participants: A sample of admitted adults without diarrhea, with oversampling of nursing facility patients. Methods: Perirectal swabs were tested by polymerase chain reaction for C. difficile within 24 hours of admission, and patients were followed for progression to symptomatic C. difficile. Development of symptomatic C. difficile was compared among C. difficile carriers and noncarriers using a Cox proportional hazards model. Results: Of the 220 subjects, 21 (9.6%) were C. difficile carriers, including 10.2% of the nursing facility residents and 7.7% of the community residents (P = .60). Among the 21 C. difficile carriers, 8 (38.1%) progressed to symptomatic C. difficile, but only 4 (2.0%) of the 199 noncarriers progressed to symptomatic C. difficile (hazard ratio, 23.9; 95% CI, 7.2–79.6; P < .0001). Conclusions: Asymptomatic carriage of C. difficile is prevalent among admitted patients and confers a significant risk of progression to symptomatic CDI. Screening for asymptomatic carriers may represent an opportunity to reduce CDI.

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